Drug trialled in Cork hospital reduces deaths from head injury

A drug trialled at Cork University Hospital (CUH) has been found to reduce deaths from head trauma by as much as 20 per cent.

The result has been described as highly significant and should help improve outcomes for those who suffer head injuries, particularly from "low falls", the types of slip-and-trip accidents that are the most common in Ireland.

"It's hugely exciting. The beauty of it is it's so cheap, easy to administer and it doesn't have a side-effect profile," explained emergency medicine consultant Dr Conor Deasy, who was principal investigator at CUH.

Medical staff at the hospital were part of a major international study of the effects of tranexamic acid (TXA) on reducing deaths in certain groups of traumatic brain injury. Published in the Lancet medical journal, the research has shown that, overall, hundreds of thousands of lives can be saved by reducing post-traumatic bleeding into the brain.

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Led by the London School of Hygiene & Tropical Medicine, the global trial examined 12,000 head-injury patients, recruited in emergency care by specially trained medical staff.

It found that where the drug was administered within three hours of the injury being sustained, the rate of death could be significantly reduced, particularly among patients with mild or moderate injuries. There was also no evidence of adverse effects or increases in disability among survivors.

TXA has already been trialled and licensed for use among those suffering abdominal and chest injuries. Moves are now likely to push for its licensing and widespread application in head trauma cases.

In Ireland, the profile of head trauma injuries has shifted over the past two decades.

Low falls

The latest major trauma audit, conducted by the National Office for Clinical Audit (Noca) and published earlier this year, found “low falls” – those from up to two metres in height – accounted for 57 per cent of all trauma, including head injuries. However, whereas head trauma was heavily associated with young people 20 years ago, that has recently shifted to a majority in the 65-plus age group.

Dr Deasy, who is also deputy medical director of the National Ambulance Service, said much of this can be explained by demographic changes – an ageing population – and lifestyle factors. For instance, he said, trauma associated with road traffic incidents have fallen as a likely result of improved conditions and behaviour.

Should TXA be approved for widespread use, those who experience such injuries now have a far better chance of survival.

Traumatic brain injury (TBI) is a leading cause of death and disability with an estimated 69 million new cases each year worldwide.

Dr Emily O'Conor, president of the Irish Association for Emergency Medicine, acknowledged the patients and their families who took part in the trial.

“Trials such as these are difficult to plan and perform, to ensure the conclusion is accurate,” she said .

“Arriving to the emergency department very sick or injured and in distress [and] being asked if you or your loved one would be willing to be recruited to a trial could be challenging, confusing and upsetting, but the outcomes of such trials are vital in identifying lifesaving interventions.”