Among patients undergoing coronary-artery surgery, tranexamic acid was associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery. Tranexamic acid was associated with a higher risk of postoperative seizures. (Funded by the Australian National Health and Medical Research Council and others; ATACAS Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639 .).

EVERE TRAUMATIC BRAIN INJURY (TBI) is common in patients with major trauma and typically involves young adult men. 1 Despite current management strategies, patients with severe TBI have a high mortality rate (31%-49%) and a large number of survivors have persistent severe neurological disability. 1-4 There are 80000 to 90 000 were cases of survivors with long-term disability after head injury annually in the United States. 5 The mean lifetime cost of each TBI survivor with severe disability from TBI exceeds US $2 million. 6 After initial head trauma, secondary brain injury may occur due to hypoxia, hypotension, or elevated intracranial pressure (ICP) and is associated with a worse neurological outcome. 3,7 Patients with hypotension after severe TBI have twice the mortality rate of normotensive patients. 5 Therefore, aggressive resuscitation with intravenous fluids is recommended in current guidelines for the management of patients with severe TBI. 8 Treatment of increased ICP in patients with TBI is also likely to improve outcomes. 3

Objective: To determine whether the statewide system of trauma care introduced in 2000 has resulted in improved survival for all major trauma patients in Victoria. Design, setting and participants: Population‐based cohort study using data from the Victorian State Trauma Registry (VSTR), a registry of all hospitalised major trauma patients in Victoria. The study included major trauma patients with an Injury Severity Score > 15 captured by the VSTR between July 2001 and June 2006. Main outcome measure: In‐hospital mortality. Results: The number of major trauma cases captured by the registry rose from 1153  in 2001–02 to 1737 in 2005–06. Adjusting for key predictors of mortality, there was a significant overall reduction between 2001–02 and 2005–06 in the risk of death for patients treated in the trauma system (adjusted odds ratio [AOR], 0.62 [95% CI, 0.48–0.80]). The reduced risk of death was also significant when road trauma cases (AOR, 0.56 [95% CI, 0.39–0.80]) and serious head injury cases (AOR, 0.62 [95% CI, 0.46–0.83]) were analysed separately. The proportion of road trauma patients definitively treated at one of the three major trauma service (MTS) hospitals in Victoria rose by 7% over the 5‐year period. Direct transfers from the scene of injury to MTS hospitals rose by 8% for all cases and 13% for road trauma cases over the same period. Conclusions: Introduction of a statewide trauma system was associated with a significant reduction in risk‐adjusted mortality. Such inclusive systems of trauma care should be regarded as a minimum standard for health jurisdictions.