A Promise to Save 100,000 Trauma Victims

Estimating the global burden of disease and injury is a challenging scientific endeavour. Reducing the global burden of disease and injury is an urgent moral obligation. To reduce the human and economic impact of injury, we need better prevention, effective and affordable treatments, and the tenacity to ensure their universal access. For bleeding trauma patients, we now have an effective treatment that is affordable and widely practicable. Road traffic victims and victims of violence made up the majority of patients enrolled in the CRASH-2 trial, which evaluated the effect of tranexamic acid in 20,211 bleeding trauma patients from hospitals in 40 countries.[4,5,6] Given within 3 hours of injury, tranexamic acid reduces the risk of bleeding to death by a third, and at less than US$10 per treatment is a fraction of the cost of a pint of blood. It is one of the most cost-effective ways to save a life that exists and could prevent over 100,000 premature deaths each year.[7,8] We have the evidence. We must use it in the service of humanity. It can take over a decade for the results of medical research to become standard practice.[9] This is too long. We invite health professionals everywhere to make a promise to their communities that they will review the new evidence on tranexamic acid and apply it to improve the care of trauma patients.

 

This promise should not be undertaken lightly. Those who care for trauma patients will need to ensure that tranexamic acid is available when required and that trauma teams know who, when and how patients should be treated. They will need to verify that the appropriate patients are being treated and soon enough. For those willing to make this commitment, we hope that the trauma promise will be made in public and with the support of the local community or victim organisation. We will celebrate those who make the pledge by publishing the names of their hospitals on the trauma promise website and on the website of the World Day of Remembrance for Road Traffic Victims, which is commemorated on the third Sunday of November every year.[10]

 

Thanks to the Global Burden of Disease Study and similar efforts, we know more about the degree and distribution of death and illness than ever before. Nevertheless, our objective is not to understand human suffering but to reduce it. Injury is a huge cause of disease burden for which we have effective prevention interventions and a highly cost-effective treatment. Thousands of premature deaths could be prevented through the use of tranexamic acid. This promise is just one opportunity to show that we have the skills to quantify suffering and the humanity to reduce it.

 

References

1. Murray CJL, Vos T, Lozano R, et al. Global burden of diseases and injuries for 291 causes in 21 regions, 1990-2010: a systematic analysis of the Global Burden of Disease 2010 study. Lancet 2012; X

2. http://www.dfid.gov.uk/r4d/pdf/outputs/R7780.pdf (accessed 12 November 2012)

3. Peden M, Scurfield R, Sleet D, Mohan D, Hyder AH, Jarawan E, Mathers C. World report on road traffic injury prevention. Geneva: World Health Organization, 2004.

4. The CRASH-2 Collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. The Lancet. 2010; 376(9734):23-32.

5. The CRASH-2 collaborators. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. The Lancet 2011;377:1096-101.

6. Roberts I, Shakur H, Ker K, Coats T, on behalf of the CRASH-2 Trial collaborators. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD004896. DOI: 10.1002/14651858.CD004896.pub3.

7. Guerriero C, Cairns J, Perel P, Shakur H, Roberts I, et al. (2011) Cost-Effectiveness Analysis of Administering Tranexamic Acid to Bleeding Trauma Patients Using Evidence from the CRASH-2 Trial. PLoS ONE 6(5): e18987. doi:10.1371/journal.pone.0018987.

8. Ker K, Kiriya J, Perel P, Edwards P, Shakur H, Roberts I. Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial. BMC Emerg Med. 2012;12:3. Epub 2012/03/03.

9. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 2011; 104: 510–20.

10. http://www.worlddayofremembrance.org/ (Accessed 19 November 2012)