The acute management of XXXX : a systematic review of randomized controlled trials.

@entity1 @entity548 @entity1003 @entity927 @entity204 @entity130
INTRODUCTION: Worldwide, @entity130 is a leading cause of @entity204 and disability. @entity548 is responsible for up to 40% of @entity130 deaths. Recent strategies to improve mortality rates have focused on optimal methods of early @entity548 control and correction of @entity1003 . We undertook a systematic review of randomized controlled trials (RCT) which evaluated @entity130 @entity1 with @entity548 within the first 24 hours of injury and appraised how the interventions affected three outcomes: @entity548 and/or transfusion requirements; correction of @entity130 induced @entity1003 and mortality. METHODS: Comprehensive searches were performed of MEDLINE, EMBASE, CENTRAL (The Cochrane Library Issue 7, 2010), Current Controlled Trials, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and the National Health Service Blood and Transplant Systematic Review Initiative (NHSBT SRI) RCT Handsearch Database. RESULTS: A total of 35 RCTs were identified which evaluated a wide range of clinical interventions in @entity548 . Many of the included studies were of low methodological quality and @entity1 numbers were small. Bleeding outcomes were reported in 32 studies; 7 reported significantly reduced transfusion use following a variety of clinical interventions, but this was not accompanied by improved survival. Minimal information was found on traumatic @entity1003 across the identified RCTs. Overall survival was improved in only three RCTs: two small studies and a large study evaluating the use of @entity927 . CONCLUSIONS: Despite 35 RCTs there has been little improvement in outcomes over the last few decades. No clear correlation has been demonstrated between transfusion requirements and mortality. The global @entity130 community should consider a coordinated and strategic approach to conduct well designed studies with pragmatic endpoints.
