Correspondence

208 www.thelancet.com Vol 382 July 20, 2013

these 34 hospitals, 34 (8%) received tranexamic acid. Four of these 34 hospitals were major trauma centres. Of 285 trauma patients transfused at these four major trauma centres, 13 (5%) received tranexamic acid.

Although tranexamic acid is included in most hospital trauma protocols, our data show that few bleeding trauma patients were given this treatment in 2011. Patients with trauma severe enough to require blood transfusion would be expected to benefit from tranexamic acid, and we are concerned that patients were denied this life-saving treatment. One explanation for the low use is that tranexamic acid might not have been incorporated into trauma protocols for the full duration of 2011. Since most hospitals now include tranexamic acid in their trauma protocols, more recent fi gures might be higher.

We will repeat this survey in 2013 to assess progress. We are optimistic that use will improve because of recent and rapid policy responses—notably, the aforementioned trauma protocol coverage, the Trauma Promise, and the NHS move to include tranexamic acid administration in its 2013–14 best practice tariff for major trauma centres.4,5 To support these efforts, we recommend that tranexamic acid be included in trauma audit at all UK accident and emergency hospitals and that hospitals regularly publish data on the proportion of trauma patients that are appropriately given the treatment. We urge all UK hospitals to reaffirm their commitment to providing effective trauma care by making the Trauma Promise.We declare that we have no confl icts of interest.

Alex Bozzette,*Amy Aeron-Thomasamy.aeron-thomas@roadpeace.org

RoadPeace, London SW9 8RR, UK

1 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 Emergency Medicine 2012; 12: 3.

Reducing trauma deaths in the UKTraumatic haemorrhage is a leading cause of death in young adults in the UK.1 The CRASH-2 trial showed that the early administration of tranexamic acid safely reduces mortality in bleeding trauma patients.2 Further study dem-on strated that the treatment is widely practicable and cost eff ective.3

RoadPeace—the UK national charity for road crash victims—represented trauma victims on the CRASH-2 trial steering committee, and we are now committed to ensuring that victims benefit from this life-saving treatment. To assess whether bleeding trauma patients in the UK are treated with tranexamic acid, we sent freedom of information requests to 291 UK hospitals in September, 2012, which asked the following questions: does your hospital’s trauma protocol include administration of tranexamic acid to bleeding trauma patients; and in 2011, how many acute trauma patients received a blood transfusion and, of those, how many were treated with tranexamic acid?

209 (72%) of the 291 hospitals responded. Of these 209 hospitals, 11 stated that they did not treat trauma patients and 19 failed to answer the question about trauma protocols. Of the 179 remaining hospitals, 159 (89%) include tranexamic acid in their trauma protocols. The second question aimed to assess whether bleeding trauma patients received tranexamic acid. Most hospitals did not answer this question (citing the pertinent Freedom of Information Act 2000 clause) on the basis that it would be too costly to obtain the data. 34 hospitals reported the number of trauma patients that received a blood transfusion and the number given tranexamic acid. Of 451 trauma patients transfused at

Department of errorThayyil S, Sebire NJ, Chitty LS, et al, for the MARIAS collaborative group. Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 2013; 382: 223–33—In this Article, in the Findings section of the Summary and in the sixth line of the Results section, the proportion of cases who were children should have been 31%. Additionally, in the last sentence of the fi rst paragraph of the Procedures section, the out-of-hours times should have been between 18 00 h and 08 00 h. These corrections have been made to the online version as of May 16, 2013, and to the printed report.

Thayyil S, Sebire NJ, Chitty LS, et al, for the MARIAS collaborative group. Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 2013; 382: 223–33—In fi gure 1, the downward arrows in rows four and fi ve should have shown N for No. In fi gure 5, panels C and D were reversed. These corrections have been made to the online version as of July 19, 2013, and to the printed report.

Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013; 382: 260–72—In this Series, the fourth sentence in the Nephrology section should have read “With the exception of Nigeria, Sudan, Kenya, and South Africa, most countries in sub-Saharan Africa have fewer than ten nephrologists”. This correction has been made to the printed Series, and to the online version as of July 19, 2013.

The CORONIS Collaborative Group. Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial. Lancet 2013; 382: 234–48—WHO copyright was incorrectly shown for this Article. Additionally, a duplicate reference has been removed. These corrections have been made to the online version as of July 19, 2013, and to the printed report.

Published OnlineMay 16, 2013

http://dx.doi.org/10.1016/S0140-6736(13)61002-8

3 The Lancet. Bringing women to the forefront of science and medicine. Lancet 2012; 379: 867.

2 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. Lancet 2011; 377: 1096–101.

3 Guerriero C, Cairns J, Perel P, et al. Cost-eff ectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PLoS One 2011; 6: 5.

4 Shakur H, Roberts I, Piot P, et al. A promise to save 100 000 trauma patients. Lancet 2012; 380: 2062–63.

5 Department of Health Payment by Results Team. Draft payment by results guidance for 2013–2014. http://www.dh.gov.uk/health/2012/12/pbr-road-test/ (accessed Jan 31, 2013).

For more on Trauma Promise see http://www.traumapromise.

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