Issue 29
October 2001
Going from strength to strength

Recruitment challenge

CRASH trial collaborators have already recruited 1,972 patients. This makes it the largest head injury trial ever conducted. It is well on track to recruiting the planned 20,000 patients, when compared to other large simple trials at a similar stage. Figure 1 (right) shows the number of new hospitals needed to take part in order to reach our target. The average recruitment of 1.8 patients per hospital per month means that another 160 hospitals need to take part. If the average rate of recruitment could be doubled, by ensuring that far fewer eligible patients are missed, less than 50 new hospitals would be required. Anything that you can do to increase your recruitment rate or to recruit more hospitals locally will be very valuable. If you have any ideas for ways in which the Co-ordinating Centre can help, or strategies that helped you recruit more, then please let us know.

Numbers randomised into trial by hospital

  • Research Institute for Special Surgery and Trauma (Czech Republic) 292
  • Centre Hospitalier Regional de Namur (Belgium) 192
  • Hope Hospital (UK) 117
  • Tygerberg Academic Hospital (South Africa) 92
  • Birmingham Heartlands Hospital (UK) 75
  • University Hospital of Zurich (Switzerland) 65
  • North Manchester General Hospital (UK) 64
  • St James's University Hospital (Eire) 57
  • Wentworth Hospital (South Africa) 57
  • Whiston Hospital (UK) 50
  • Batticaloa General Hospital, Teaching (Sri Lanka) 48
  • Trauma Centre - Virgen Del Rocio (Spain) 48
  • Clinica Las Americas (Colombia) 43
  • Hospital University Science Malaysia (Malaysia) 39
  • National Hospital of Sri Lanka (Sri Lanka) 39
  • Spitalul Clinic de Urgenta Bucuresti (Romania) 38
  • Colchester General Hospital (UK) 35
  • Reimann Hospital (Slovakia) 33
  • Eastbourne District General Hospital (UK) 32
  • Royal Bolton Hospital (UK) 31
  • Mataria Teaching Hospital (Egypt) 30
  • Selly Oak Hospital (UK) 30
  • Suez Canal University (Egypt) 28
  • Royal Albert Edward Infirmary (UK) 26
  • Stepping Hill Hospital (UK) 24
  • Trafford General Hospital (UK) 23
  • Hospital General de Medellin (Colombia) 18
  • Masaryk Hospital (Czech Republic) 17
  • Blackburn Royal Infirmary (UK) 16
  • Royal Oldham Hospital (UK) 16
  • Hospital San Bernardo (Argentina) 16
  • A.Z. Kliena Hospital (Belgium) 15
  • Countess of Chester Hospital (UK) 14
  • Cheltenham General Hospital (UK) 13
  • Queen Elizabeth The Queen Mother
  • Hospital (UK) 13
  • Bury General Hospital (UK) 13
  • Northern General Hospital (UK) 13
  • Princess Alexandra Hospital (UK) 13
  • Furness General Hospital (UK) 12
  • Queen Elizabeth Hospital, Birmingham (UK) 11
  • Lagos University Teaching Hospital (Nigeria) 11
  • Worthing Hospital (UK) 10
  • Royal Liverpool University Hospital (UK) 9
  • Hospital Escuela (Argentina) 8
  • Ninewells Hospital and Medical School (UK) 8
  • Aberdeen Royal Infirmary (UK) 8
  • Hospital Pribram (Czech Republic) 7
  • Ernst Moritz Arndt University (Germany) 7
  • Hospital Municipal "Dr Leonidas Lucero" (Argentina) 7
  • University Hospital Hradec Kralove (Czech Republic) 7
  • Hospital Italiano (Argentina) 6
  • National Neuroscience Institute (Singapore) 6
  • Hospital of Jolimont (Belgium) 6
  • Medway Maritime Hospital (UK) 5
  • Dunedin Hospital (New Zealand) 5
  • Withybush General Hospital (UK) 4
  • Hospital Municipal Dr Hector J D'Agnillo (Argentina) 4
  • Hospital Provincial Neuquen (Argentina) 4
  • Chesterfield & North Derbyshire Royal Hospital (UK) 4
  • Prof Dr D Bagdasar Clinical Emergency Hospital (Romania)4
  • City Hospital (UK) 4
  • Instituto de Prevision Social (Paraguay) 3
  • Chelsea and Westminster Hospital (UK) 3
  • KAT Hospital of Athens (Greece) 3
  • José Penna (Argentina) 3
  • Hospital "Heroes de Malvinas" (Argentina) 2
  • Doncaster Royal Infirmary (UK) 2
  • Narh-Bita Hospital (Ghana) 2
  • Arrowe Park Hospital (UK) 1
  • Hospital Español (Argentina) 1
  • Univerzity Karlovy Neurochirurgicka Klinika (Czech R) 1
  • Hospital Nacional Profesor Alejandro Posadas (Argentina) 1
  • Ospedale San Martino (Italy) 1
  • Institute Of Neurology (UK) 1
  • Kantonsspital Schaffhausen (Switzerland) 1
  • Harrogate District Hospital (UK) 1
  • King George Hospital (UK) 0
  • University Hospital of Brooklyn (USA) 0
  • St Helier Hospital (UK) 0
  • North Staffordshire Royal Infirmary (UK) 0
  • MetroHealth Medical Center (USA) 0
  • Makerere Medical School (Uganda) 0
  • Istambul Medical Faculty (Turkey) 0
  • Kreiskrankenhaus Tirschenreuth (Germany) 0
  • Clinica Los Rosales S.A. (Colombia) 0
  • Hospital Universitario San Jorge (Colombia) 0
  • Hospital Mútua de Terrassa (Spain) 0
  • Lister Hospital (UK) 0
Web access to data for trial collaborators

As the CRASH Trial continues to grow, there will be hundreds of doctors and nurses around the world recruiting patients and helping to promote the Trial. In addition to keeping collaborators up-to-date with our monthly newsletter and weekly fax, we are now planning to provide collaborators with access to
summary data through the WorldWideWeb. Collaborators will be able to produce some simple analyses, such as the number of patients by baseline characteristics, or by outcome (for both treatment groups combined). In addition, we will also create a CRASH Trial ‘Discussion Forum’ for collaborators, and enable those helping with long-term follow-up to produce anonymised lists of patients followed-up and for whom follow-up is due. To make all this happen, we are fortunate to have Adrian Ritchie working with us on an industrial placement from the University of Hertfordshire. Adrian has several years expertise in Internet and Web software development but even more importantly, he has 21 years experience as Nin’s brother!!

First 1,000 patients publication

A paper based on the analysis of the first 1,000 patients randomised in the pilot phase has now been written and submitted for publication. As well as describing the design of the MRC CRASH Trial, it also presents baseline data and outcome data (for both treatment groups combined) for the first 1,000 patients. The lead collaborators and nurses of each of the hospitals participating in the pilot phase will be named in the paper. We shall send a copy of the paper to every collaborator as soon as it is published.

Two centres in USA have now obtained ethics approval: Johnny Duldner in MetroHealth Medical Center, Ohio, and Jean Charchaflieh in University Hospital of Brooklyn/Kings
County Hospital Centre, New York. Also Mathias Kalkum, Kreiskrankenhaus Tirschenreuth, Germany has ethics approval and all of these new centres should start enrolling patients very soon.

Urs Denzler in Kantonsspital Schaffhausen in Switzerland obtained ethics approval and immediately enrolled their first patient into the trial. Also the following centres have now started randomising: Eros Bruzzone and team in Ospedale San Martino, Italy, Juan Carlos Arjona Linares, Hospital Español, Argentina, Walter Videtta, Hospital Nacional Profesor Alejandro Posadas, Argentina and Silvana Svampa, Hospital Provincial Neuquen, Argentina.

Further congratulations go to Mandy Grocutt and Steve Chambers in Worthing Hospital for enrolling their 10th patient and

to Sarah Graham and Sandra Bathgate (right) in Whiston Hospital for enrolling 50 patients into the CRASH Trial.

Other centres to have previously reached this milestone, as well as other high achievers are shown on the left.

The team at the co-ordinating centre is glad to welcome back Reshma Mashru
(Data Manager) to deal with the Early Outcome data. You can contact her at

Nin Ritchie, MRC CRASH Trial Manager
CRASH Co-ordinating Centre, LSHTM, 49-51 Bedford Square, LONDON

Tel:+44(0)20 7299 4684    Fax:+44(0)20 7299 4663    email: