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Reducing death in trauma - Taking Action: United Nations Decade of Action for Road Safety 2011-2020

Press release 11 May 2011

As the UN Decade of Action for Road Safety launches today on 11 May 2011 a world first clinical trial, testing a new way of stopping blood loss from major trauma, has published results showing an inexpensive drug substantially reduces the risk of death when given early and could prevent up to 100,000 deaths per year across the world.

Road traffic accidents are a major cause of severe trauma and 1.3 million people are killed on the world's roads each year.

The trial's cost-effectiveness results published in the Public Library of Science, 3 May 2011 PLoS ONE 6(5): e18987. They revealed that early administration (within three hours) of tranexamic acid (TXA) would cost $48, $66 and $64 per life years saved in Tanzania, India and the UK respectively. This is equivalent to a year of life that could be saved for around the price of filling up the tank of an average family car.

"This is a fitting comparison bearing in mind that most of the patients who will benefit from this cheap life saving drug have been hit by cars," commented lead research Professor Ian Roberts from the London School of Hygiene and Tropical Medicine.

Funded by the National Institute of Health Research Health Technology Assessment (NIHR HTA) programme, the CRASH-2 trial was the largest trial of its kind, involving up to 20,000 patients across the globe from 274 hospitals in 40 countries. It studied the number of deaths in hospital within four weeks of injury and showed that early administration of tranexamic acid to patients with recent, severe bleeding injuries saves lives.

The United Nations has launched a 'Decade of Action for Road Safety' with the aim of stabilising and then reducing global road deaths by 2020. The CRASH-2 trial reduced the chances of death due to massive blood loss by about one sixth and had no evidence of adverse effects from unwanted clotting.

The researchers estimate that in India it could save about 13,000 lives from trauma each year, with about 12,000 lives saved in China. The drug would also save lives in developed countries, around 2,000 each year in the USA and more in Europe.

Severely injured adults were enrolled in the trial if they were at risk of or had significant bleeding and were within a few hours of injury. Patients were split into two groups; one group received TXA and the other group received a placebo. TXA is a treatment widely used in major surgery and the effectiveness for reducing blood loss in trauma patients had never been tested before.

Dr. Etienne Krug, Director of Violence and Injury Prevention and Disability at WHO said, "The economic and social cost of injury is enormous, with most of the burden in low and middle income countries. Prevention is critical, but even with the best efforts there will still be millions of patients requiring emergency treatment, which is why these results are so important. The drug is inexpensive and could be given in hospitals world-wide. It is essential that doctors are aware of these results and take them into account in the emergency management of seriously injured patients."

Professor Dame Sally C Davies, Chief Medical Officer, said: "I am delighted that through the NIHR, the Department of Health has funded this research which shows that TXA can be used safely on patients with recent, severe bleeding caused by injury. This is a great example of how important research can help the NHS save more lives and spread best practice around the world."

CRASH-2 has also gained support from the World Health Organisation Blood Transfusion Team, The European Federation of the Victims of Road Traffic Injuries, The Lancet and the Ministry of defence.

The final results will be published in 2012 in the Health Technology Assessment journal www.hta.ac.uk/1604