Improving trauma care demands large trials—and large trials need funding and collaboration

For people aged 5-45 years trauma is second only to HIV/AIDS as a cause of death.1 2 Every day world wide over 300 000 people are severely injured, about 10 000 of whom die. Road traffic crashes and violence are the leading causes. The global number of road deaths is forecast to rise by 65% between 2000 and 2020 and the number of violent deaths has increased steadily, with the 20th century being the most violent on record. Despite the best preventive efforts, providing effective trauma care will remain a major challenge for healthcare professionals. There is considerable potential to improve trauma outcomes by using clinical audit to increase the implementation of evidence based interventions in trauma services.3 However, for many trauma care interventions, the balance of risks and benefits is uncertain and they must be assessed in randomised trials before being implemented.

Compared with the disease burden there is a dearth of clinical trials in trauma care and the existing trials are small, contributing to uncertainty about effectiveness (see table).4 For example, few if any of the pharmacological treatments for brain and …