{"id":10,"date":"2020-09-03T14:04:06","date_gmt":"2020-09-03T14:04:06","guid":{"rendered":"https:\/\/crash4.lshtm.ac.uk\/?page_id=10"},"modified":"2024-11-26T09:30:58","modified_gmt":"2024-11-26T09:30:58","slug":"home","status":"publish","type":"page","link":"https:\/\/crash4.lshtm.ac.uk\/index.php\/home\/","title":{"rendered":"About the Trial"},"content":{"rendered":"\t\t
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Current Trial Protocol<\/p>\n

& Summary<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Trial Protocol
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Protocol Summary
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Previous Trial Protocols<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Trial Protocol
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Trial Protocol
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Protocol Summary
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Trial Overview<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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A fall from standing height in older adults is the commonest cause of major trauma in the UK. <\/span><\/p>\n

Traumatic brain injury (TBI) accounts for half of trauma admissions in older adults and is a leading cause of death and disability.
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Because the UK population is steadily ageing, the number of older adults with TBI will continue to rise. <\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Most (90%) of the 1.4 million TBI patients seen each year in emergency departments in England and Wales have mild (Glasgow Coma Scale (GCS) score 13-15) head injury, but the term \u2018mild\u2019 is misleading in older adults who have higher death rates and worse outcomes than younger patients. <\/span><\/p>

Due to increased use of anticoagulant and antiplatelet drugs, older adults are more likely to suffer intracranial bleeding after mild TBI. TBI is also a strong risk factor for dementia in older adults.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Trial Aim &
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Intervention
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The CRASH-4 trial aims to provide reliable evidence about the effects of early intramuscular TXA on intracranial haemorrhage, disability, death and dementia in older adults with symptomatic head injury.<\/span><\/p>\n

Tranexamic acid (TXA) reduces bleeding by inhibiting the enzymatic breakdown of fibrin blood clots. Results from randomised trials (CRASH-3 and NCT01990768) show that early treatment with TXA reduces head injury deaths (pooled RR 0.89, 95% CI 0.80-0.99).
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In the CRASH-3 trial, the reduction in head injury deaths with TXA was largest in patients with mild and moderate head injuries, particularly if patients were treated soon after injury.
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However, the CRASH-3 trial included mild TBI patients only if they had intracranial bleeding on CT scan.
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It is uncertain whether the results apply to mild TBI patients more generally.<\/span><\/span><\/p>\n

Intracranial bleeding occurs soon after injury and early treatment is most effective. We have shown that TXA is rapidly absorbed after intramuscular injection in trauma patients without local side effects.
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This means that paramedics can give intramuscular TXA before transport to hospital, and for those who do not travel by ambulance, intramuscular TXA can be given immediately on hospital arrival.
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If early intramuscular TXA treatment reduces death and disability in older adults with mild TBI this would be a major medical advance that would improve the care of many millions of patients in the UK and world-wide.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Find out more about the trial<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Training Materials<\/a><\/strong><\/p>\n

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Learn How to Carry out Trial Procedures<\/p>\n

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Our Collaborators<\/a><\/strong><\/p>\n

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Our collaborating sites<\/p>\n

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Join our collaboration<\/strong><\/a><\/p>\n

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Express your interest<\/p>\n

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<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Current Trial Protocol & Summary Trial Protocolv3.0 Protocol Summaryv3.0 Previous Trial Protocols Trial Protocolv2.0 Trial Protocol v1.3 Protocol Summaryv2.0 Protocol Summary v1.3 Trial Protocol v1.2 Trial Protocol v1.1 Trial Overview A fall from standing height in older adults is the commonest cause of major trauma in the UK. Traumatic brain injury (TBI) accounts for half<\/p>\n<\/i>Details<\/span><\/i><\/span><\/a>","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-10","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/crash4.lshtm.ac.uk\/index.php\/wp-json\/wp\/v2\/pages\/10","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/crash4.lshtm.ac.uk\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/crash4.lshtm.ac.uk\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/crash4.lshtm.ac.uk\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/crash4.lshtm.ac.uk\/index.php\/wp-json\/wp\/v2\/comments?post=10"}],"version-history":[{"count":380,"href":"https:\/\/crash4.lshtm.ac.uk\/index.php\/wp-json\/wp\/v2\/pages\/10\/revisions"}],"predecessor-version":[{"id":2934,"href":"https:\/\/crash4.lshtm.ac.uk\/index.php\/wp-json\/wp\/v2\/pages\/10\/revisions\/2934"}],"wp:attachment":[{"href":"https:\/\/crash4.lshtm.ac.uk\/index.php\/wp-json\/wp\/v2\/media?parent=10"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}