A promise to save 100â€ˆ000 trauma patients
A promise to save 100 000 trauma patients
In The Lancet
, Christopher Murray and colleagues present trauma patients. Please visit the Trauma Promise website the ﬁ ndings of their 2010 Global Burden of Disease to sign up and make the promise.
Study, in which they show that injuries cost the global
This promise should not be undertaken lightly. Those
population some 300 million years of healthy life every who care for trauma patients will need to ensure that year, causing 11% of disability-adjusted life years (DALYs) tranexamic acid is available when needed and that trauma worldwide.1 Road-traﬃ
c crashes were the number teams know who, when, and how patients should be
one killer of young people and accounted for nearly a treated. They will need to verify that the appropriate third of the world injury burden—a total of 76 million patients are being treated, and whether or not they receive DALYs in 2010, up from 57 million in 1990. Most of treatment soon enough after trauma. For those willing
the victims were young, and many had families that to make this commitment, we hope that the trauma
pages 2053, 2054,
depended on them. A study in Bangalore showed that promise will be made in public and with the support of the
the extra health-care costs and reduced income after local community or victim organisation. We will celebrate
See Special Report
pages 2071, 2095,
c crash force most poor households into those who make the pledge by publishing the names of
debt, with reduced food consumption for the victim’s their hospitals on the Trauma Promise website and on the
For the Trauma Promise
family.2 A large share of these road-traﬃ
c injuries could website of the World Day of Remembrance for Road Traﬃ
be prevented with available road safety interventions.3 Victims, which is commemorated on the third Sunday of
For the World Day of
Violence also accounted for much human suﬀ ering, November every year.
Remembrance for Road Traﬃ
especially in Latin America and sub-Saharan Africa. Once
Thanks to the Global Burden of Disease Study 2010
again, the young bore most (81%) of the burden.
and similar eﬀ orts, we know more about the extent
Estimation of the global burden of disease and injury and distribution of death and illness than ever before.
is a challenging scientiﬁ c endeavour. Reduction of the Nevertheless, our objective is not to understand human global burden of disease and injury is an urgent moral suﬀ ering but to reduce it. Injury is a huge cause of obligation. To reduce the human and economic eﬀ ect disease burden for which we have eﬀ ective prevention of injury, we need better prevention, eﬀ ective and interventions and a highly cost-eﬀ ective treatment. aﬀ ordable treatments, and the tenacity to ensure their Thousands of premature deaths could be prevented universal access. For bleeding trauma patients, we now through the use of tranexamic acid. This promise is have an eﬀ ective treatment that is aﬀ ordable and widely just one opportunity to show that we have the skills to practicable. Road-traﬃ
c victims and victims of violence quantify suﬀ ering and the humanity to reduce it.
constituted most patients in the CRASH-2 trial, which assessed the eﬀ ect of tranexamic acid in 20 211 bleeding Haleema Shakur, *Ian Roberts, Peter Piot, Richard Horton,
trauma patients from hospitals in 40 countries.4,5 Given Etienne Krug, Jeannot Mersch
within 3 h of injury, tranexamic acid reduced the risk London School of Hygiene and Tropical Medicine, London of bleeding to death by a third, and at less than US$10 WC1E 7HT, UK (HS, IR, PP); The Lancet
, London, UK (RH); WHO,
Geneva, Switzerland (EK); and European Federation of Road
per treatment is a fraction of the cost of a pint of blood. Traﬃ c Victims, Luxembourg City, Luxembourg (JM)
Subsequent studies showed that tranexamic acid is cost [email protected]
ﬀ ective and could prevent more than 100 000 pre-
We declare that we have no conﬂ icts of interest.
mature deaths every year.6–8 On the basis of the CRASH-2 1
Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for
trial results, tranexamic acid was included on the WHO
291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis
for the Global Burden of Disease Study 2010. Lancet
list of essential medicines. We have the evidence—we 2 Aeron-Thomas A, Jacobs GD, Sexton B, Gururaj G, Rahman F.
The involvement and impact of road crashes on the poor: Bangladesh and
must use it in the service of humanity. It can take more
India case studies. July, 2004. http://www.dﬁ d.gov.uk/r4d/pdf/outputs/
than a decade for the results of medical research to
Peden M, Scurﬁ eld R, Sleet D, et al. World report on road traﬃ
become standard practice.9 This is too long. We invite
prevention. Geneva: World Health Organization, 2004.
health professionals everywhere to make a promise to 4 The CRASH-2 Collaborators. Eﬀ ects of tranexamic acid on death, vascular
occlusive events, and blood transfusion in trauma patients with signiﬁ cant
their communities that they will review the new evidence
haemorrhage (CRASH-2): a randomised, placebo-controlled trial.
on tranexamic acid and apply it to improve the care of
www.thelancet.com Vol 380 December 15/22/29, 2012
The CRASH-2 collaborators. The importance of early treatment with
Roberts I, Shakur H, Ker K, Coats T, CRASH-2 trial collaborators.
tranexamic acid in bleeding trauma patients: an exploratory analysis of the
Antiﬁ brinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev
CRASH-2 randomised controlled trial. Lancet
Guerriero C, Cairns J, Perel P, et al. Cost-eﬀ ectiveness analysis of
Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question:
administering tranexamic acid to bleeding trauma patients using evidence
understanding time lags in translational research. J R Soc Med
from the CRASH-2 trial. PLoS One
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
GBD 2010: design, deﬁ nitions, and metrics
The Global Burden of Diseases, Injuries, and Risk Factors developed; most notably, the prevalence of diseases and See Comment
pages 2053, 2054,
(GBD) enterprise is a systematic, scientiﬁ c eﬀ ort to their sequelae is estimated using statistical inference on 2055, 2058, 2060, and 2062
See Special Report
quantify the comparative magnitude of health loss due all available data.
pages 2071, 2095,
to diseases, injuries, and risk factors by age, sex, and
A key aspect of the study is the hierarchical cause list 2129, 2144, 2163, 2197, and 2224
geography for speciﬁ c points in time. The GBD construct for 291 diseases and injuries. This list has four levels of the burden of disease is health loss, not income or of diseases and injuries and a ﬁ fth level for sequelae productivity loss.1 For decision makers, health-sector (appendix p 6). The 1160 sequelae are designed to leaders, researchers, and informed citizens, the GBD capture the direct consequences of disease or injury approach provides an opportunity to see the big picture, that are not otherwise captured elsewhere in the cause to compare diseases, injuries, and risk factors, and to list. Across sequelae, there are 220 common sequelae understand in a given place, time, and age-sex group called health states in GBD 2010. For example, anaemia what are the most important contributors to health loss.
is identiﬁ ed as a sequela of 19 diseases in the cause list.
The Global Burden of Disease Study 2010 (GBD 2010) Three health states are associated with anaemia: mild
builds on the earlier versions for 1990, 1999–2002, anaemia, moderate anaemia, and severe anaemia. For
and 2004 sponsored by the World Bank and WHO.2–10 A each of the health states, a lay description was developed
more thorough description of the context, objectives, for use in the empirical assessment of disability weights.
key deﬁ nitions, and metrics used in GBD 2010 is As with diseases, we have developed a hierarchical list of
provided in the appendix. Previous GBD studies have 69 risk factors for which we have developed estimates See Online
led to national burden of disease studies in at least for 67 (appendix p 6).
37 countries and subnational studies in eight countries.
We divided countries into 21 regions on the basis
GBD 2010 was implemented as a collaboration between of two criteria: epidemiological homogeneity, and seven institutions: the Institute for Health Metrics and geographical contiguity (appendix pp 6–7). For some Evaluation as the coordinating centre, the University of statistical analyses, we grouped regions into seven Queensland School of Popu lation Health, the Harvard super-regions. To facilitate various detailed analyses, School of Public Health, the Johns Hopkins Bloomberg we estimate the burden of disease in 20 age groups School of Public Health, the University of Tokyo, Imperial for each sex separately: early neonatal, late neonatal, College London, and WHO. The study was designed to postneonatal, 5 year age groups from 1–4 years to address key limitations of previous studies, such as the 75–79 years, and 80 years and older. Using strictly absence of uncertainty intervals, and to solicit the input comparable data and methods, we have estimated of many expert advisers across the spectrum of diseases the burden of disease for 1990, 2005, and 2010 to and risk factors. This study represents a great expansion allow meaningful estimation of time trends. This study in the scope of work from previous GBD revisions, supersedes all previously published GBD study results.
including a larger disease and injury cause list, more risk
Figure 1 summarises the overall analytical strategy
factors, many more age groups, and an assessment for for GBD 2010 and identiﬁ es 18 distinct components. three time periods. Furthermore, a completely revised The strong interconnections between components and improved set of estimation methods has been mean that changes in one component require the
www.thelancet.com Vol 380 December 15/22/29, 2012
British and American Pronunciation Snezhina Dimitrova In 1877, the British philologist Henry Sweet said that within a century “England, America, and Australia will be speaking mutually unintelligible languages owing to their independent changes of pronunciation.” Fortunately, this grim prediction did not come true. Still, more than 300 million people in the world today speak English
PUNKALAITUMEN KUNNASSA RAKENNUSVALVONNAN TARKASTUS- JA VALVONTATEHTÄVISTÄ SEKÄ MUISTA VIRANOMAISTEHTÄVISTÄ SUORITETTAVAT MAKSUT 1 § YLEISTÄ Luvan hakija tai toimenpiteen suorittaja on velvollinen suorittamaan tarkastus- ja valvontatehtävistä sekä muista viranomaistehtävistä kunnalle maksun, jonka perusteet määrätään tässä taksassa maankäyttö- ja rakennuslain (MRL)