Recruitment is excellent with the numbers entered rising rapidly. Most (66%) patients were treated within 4 hours of injury. Congratulations to all. 

• Cheltenham General Hospital
• Eastbourne District General Hospital 
• Hope Hospital, Manchester 
• Queen Elizabeth Hospital, Gateshead 
• Queen Elizabeth and Queen Mother, Kent 
• Research Institute for Surgery and Trauma, Czech Rep 
• Royal Bolton Hospital

Patient X was admitted to a collaborating hospital with a head injury (GCS 10) following an assault with a scaffolding pole and was immediately randomised into the CRASH trial. The one-hour loading infusion was given in the emergency department and the first maintenance infusion was started. However, soon afterwards the patient was found to have spinal cord injury with a burst fracture at T7. In consultation with neurosurgical colleagues, at the regional neurosurgical unit the patient was being transferred to, it was decided that the patient should be started on high dose methylprednisolone treatment for the spinal cord injury. Before this could be given it was important to find out whether the patient had already received a loading dose of methylprednisolone in the CRASH Trial. The allocated treatment was therefore unblinded by calling the 24 hour randomisation service.

Notes on unblinding:

In general there should be no need to unblind the allocated treatment. If a contra-indication to corticosteroids develops after randomisation the trial treatment should simply be stopped. However, this situation was one in which clinical management depended importantly upon knowledge of whether the patient received corticosteroid or placebo and thus it was completely appropriate to unblind. 
 

Marina de Leo is now working alongside Stefano Ricci, in Italy. The first Italian collaborating centres should start randomising in June. 

If you have any problems or questions about the CRASH Trial, a member of the CRASH team is on call and can be contacted by calling the 24-hour FREEPHONE randomisation service (0800 585 323).