Issue 7 Autumn 2006

CRASH2 logo

Regional focus: NIGERIA
The success of the first NIGERIAN NATIONAL CRASH-2 COLLABORATORS MEETING is clearly evident from the smiling faces in the photographs. Brilliantly organised by Edward Komolafe (Nigerian national co-ordinator) and hosted by Obafemi Awolowo University Teaching Hospital at Ile Ife, the collaborators meeting was a huge success. It was attended by collaborators from all over Nigeria – from Calabar in the east to Ilorin in the west, from Sokoto in the north to Lagos in the south and many many cities in between.

The meeting provided an excellent opportunity to discuss issues of concern and to share experiences about how to take the trial forward. Every collaborating hospital presented their experience of the trial to date and their plans to increase patient recruitment and identify new hospitals in order to continue to expand the trial network. These plans are already underway and yielding results. The meeting also provided an opportunity for on-site data audit which confirmed that the standard of data throughout was excellent. The overall conduct of the trial in Nigeria was extremely impressive – a testament to the integrity, diligence and sheer dedication of our Nigerian collaborators.

Ile-Ife was a marvellous setting for the meeting – at the superb and enormous university campus set within beautiful parklands and forest – also the home of many thousands of bats which at dusk swooped around the trees so thickly that night appeared to have come sooner than it ought. Thanks again to Edward Komolafe and all who participated for making this meeting such a resounding success.

Lagos State team
Emergency nurses at Lagos State UTH, with Dr Sanni

Meeting participants
Dr Afolabi from Ibadan and Dr Komolafe from Ile-Ife

Meeting participants
From left Dr Aminu & Dr Khalid from Ahmadu Bello UTH, Lin Barnetson, Dr Ndoma-Egba from Calabar, Ian Roberts, Dr Olaomi from Abuja, Dr Ngim from Calabar

trial progress now published on PLoS Clinical Trials

Improving the Evidence Base for Trauma Care: Progress in the International CRASH-2 Trial

If this link does not work, please go to and search for CRASH

new faces in the trials coordinating centre

Pauline Brocard

"I started working with the Trials Co-ordinating Centre in August 2006 and help with all aspects of the trials from start to finish. I have previous experience working in clinical trials and a PhD in Epidemiology, but I am new to trauma and so excited to learn more about this fascinating area and to be able to help in such an under-researched field. If you have any questions please feel free to contact me as I am here to help."
Pauline Brocard, Research Fellow
"My previous role was an administrative one, but I have recently gained a Masters in Public Health Nutrition and am looking forward to making a positive contribution as part of the CRASH2 administrative team."
Eni Balogun, Clinical Trial Associate
Eni Balogun

Cochrane logoCochrane Corner

High dose mannitol: An effective treatment for head injury... but are the data real?

Each year, worldwide, millions of people are treated in emergency departments following severe head injuries. Mannitol, an osmotic diuretic, may be effective in reducing raised intracranial pressure after head injury and is often used in the treatment of head injury patients.

Between 2001 and 2004, three reports were published by Dr Julio Cruz and colleagues presenting the results of three clinical trials comparing early high dose mannitol with conventional doses of mannitol in patients with head injury. The trial results showed that high dose mannitol was dramatically effective in reducing mortality and disability. The results were incorporated into a systematic review that was published on the Cochrane Library. The review concluded that “high dose mannitol appears to be preferable to conventional dose mannitol in the acute management of comatose patients with severe head injury.”

However, earlier this year, Dr Jorge Mejia Mantilla, the Colombian National Co-ordinator of the CRASH-2 trial, communicated to the Cochrane Injuries Group that there were concerns about the Cruz reports after hearing from Brazilian neurosurgical colleagues that there were grounds to question the integrity of the Cruz trials. In response, the Cochrane Injuries Group undertook a detailed investigation in which attempts were made to find out where the patients were recruited and to access the original trial data for external validation.

Despite considerable efforts the Group is unable to provide reassurance about the integrity of trial data. Specifically, it was unable to determine if or where the trials had taken place. Consequently, the trials in question have been removed from the systematic review. The Cochrane Injuries Group is grateful to Dr Mejia Mantilla for bringing these concerns to our attention.

Full texts of all of our reviews and protocols are published on For a complete list of titles please visit

If you are interested in becoming a member of the Cochrane Injuries Group and/or in undertaking a systematic review, email the Review Group Co-ordinator Katharine Ker at

CRASH2 teams around the world
"For our emergency team it is a great honour to participate in this international research initiative in which there is a common interest in finding reliable answers for trauma patients with significant bleeding. Come on CRASH-2 Team – count on us for future CRASH Studies!"
Andrés Villarreal, Fundación Hospital San Jose de Buga, Colombia
San Jose de Buga
"We decided to participate in the CRASH2 Trial because we are located in an area where we receive a great influx of trauma patients. We know the CRASH Coordinating Team from the CRASH1 Trial and consider it to be one of the best. The result of the CRASH2 Trial will be very useful for our patients, our guidelines and also for continuing doing research in countries such as ours, with a large number of trauma patients but with few research initiatives."
Andrés Rubiano, Hospital Universitario de Neiva, Colombia
Team from Neiva
Tamar Gogichaishvili The CRASH2 trial is now up and running in two hospitals in Georgia, with another two awaiting final approvals. The trial has made an excellent start at the Neurosurgery Department of Tbilisi State Medical University Central Clinic. It is of our great honour that our team is participating in the large international
clinical trial. It is very important for us because in Georgia, as in many other regions in the world, trauma is a major cause of death and disability, and blood transfusion as a life saving procedure is not without complications. To help improve outcomes following traumatic injuries – that’s the reason why we joined the CRASH2 trial.
The CRASH2 trial will answer an important question which could have worldwide application in trauma management and there is every reason to expect that this trial will be a success.

Tamar Gogichaishvili, Georgia national co-ordinator

Congratulations for randomising their
first patient
Frank Baillie and Rada Petrovic, Hamilton General Hospital, Canada
Andrés Villarreal, Fundacion Hospital San Jose de Buga, Colombia
Fabian Yánez, Hospital "Dr Rafael Rodriguez Zambrano", Ecuador
Premkumar Karuthillath, Calicut Medical College Hospital, India
Satish Dharap, LTM Medical College and General Hospital, India
Adefemi Afolabi, University College Hospital Ibadan, Nigeria
Branko Djurovic and Ranka Krunic, Klinicki Centar Srbije, Serbia & Montenegro
Jozef Valky, Faculty Hospital F D Roosevelta, Slovakia
Anton Laincz, NsP Poprad, Slovakia
Andrew Webster and Iain Edgar, Royal Lancaster Infirmary, UK

Welcome to the international trauma network
new ethics approvals
Andres M Rubiano, Hospital Universitario de Neiva, Colombia
Giovanna Perone, Spedali Civili di Brescia, Italy
Jorge Reis, Centro Hospitalar de Vila Nova de Gaia, Portugal

countries with 100+ recruitment

Background photo: Spedali Civili di Brescia, Italy

special mentions

Mario Izurieta
Mario Izurieta
Hospital Luis Vernaza

Yashbir Dewan
Yashbir Dewan
Christian Medical College

R R Ravi
R R Ravi
Medical Trust Hospital Kochi

Sanjay Gupta
Sanjay Gupta
Sri Sai Hospital

Bassim Irheim
Bassim Irheim
Diwaniyah College of Medicine

Surakrant Yutthakasemsunt
Khon Kaen Regional Hospital, Thailand

Moch Dwikoryanto
Soebandi Hospital Jember, Indonesia

Tamar Gogichaishvili
Tbilisi State Medical University Central Clinic, Georgia

Wilson Gualteros
Hospital Universitario San Jorge, Colombia

Fatos Olldashi
National Trauma Centre Hospital, Albania