The CRASH-3 trial is a multi-centre, randomised, placebo-controlled trial of the effects of tranexamic acid on death and disability in patients with traumatic brain injury (TBI).

Patients with reactive pupils and/or mild to moderate GCS may have benefited from tranexamic acid (TXA) in the CRASH-3 trial because they had less intracranial bleeding at baseline. However, because bleeding occurs soon after injury, treatment delay reduces the benefit of TXA.

Patients with any un-reactive pupil had a median intracranial bleeding volume of 60 ml (IQR 18–101 ml) and patients with reactive pupils had a median volume of 26 ml (IQR 1–55 ml).

Patients with severe GCS had median intracranial bleeding volume of 37 ml (IQR 3–75 ml) and patients with moderate to mild GCS had a median volume of 26 ml (IQR 0.4–50 ml).

The CRASH-3 IBMS is an explanatory study nested within the CRASH-3 trial.

We measured the volume of intracranial bleeding on CT scans using established methods (e.g. ABC/2).

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