A promise to save 100 000 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 See Comment 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 page 2067
See Articles 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 website
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
Victims see http://www.
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 Merschwithin 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 2012; 380: 2197–223.
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 Lancet 2010; 376: 23–32.
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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 2011; 377: 1096–101.
2011; 1: CD004896.
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 2011; from the CRASH-2 trial. PLoS One 2011; 6: e18987.
104: 510–20.
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.
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 page 2067
quantify the comparative magnitude of health loss due all available data.
See Articles 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 for appendix
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

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