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. 2015 May 9;2015(5):CD004896. doi: 10.1002/14651858.CD004896.pub4

McMichan 1982.

Methods Randomised controlled trial.
Participants 77 patients with a combination of hypovolaemic shock and major fractures of the lower limb and or pelvis. Patients seen 12 or more hours after injury and those with major head or chest injuries were excluded.
Age was reported by group (intervention = 30.9 +/‐ 18.4; placebo = 36.2 +/‐ 20.2).
Interventions Aprotinin group: 500,000 Kallikrein Inhibitor Units (KIU) IV statim (immediately) followed by 300,000 KIU at 6‐hour intervals for 96 hours.
Setting: Alfred Hospital, Melbourne, Australia
Outcomes Death.
 Mean blood transfusion.
 Respiratory function.
Notes It was noted in the results that the data on transfusion requirement was found to have a non‐normal distrubution. Nevertheless, the mean and standard deviation were presented.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Not described.
Allocation concealment (selection bias) Low risk "The placebo was supplied in similar ampoules...All ampoules were in boxes of 50, with a code number assigned to each box." (pg 108)
Blinding of participants and personnel (performance bias) 
 Death, vascular occlusive events, intracranial bleeding Low risk "The nature of the contents of ampoules was not known to any of the investigators nor to any of the attending physicians. The codes were not broken until the conclusion of the study". (pg 108)
Blinding of participants and personnel (performance bias) 
 Surgical intervention, blood transfusion Unclear risk "The nature of the contents of ampoules was not known to any of the investigators nor to any of the attending physicians. The codes were not broken until the conclusion of the study". (pg 108)
Blinding of outcome assessment (detection bias) 
 Death, surgical intervention, blood transfusion Low risk "The nature of the contents of ampoules was not known to any of the investigators nor to any of the attending physicians. The codes were not broken until the conclusion of the study". (pg 108)
Blinding of outcome assessment (detection bias) 
 Vascular occlusive events, intracranial bleeding Unclear risk Data on these outcomes were not reported.
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk Reported that 7 patients were excluded. 3 died within first 24 hours, 1 was transferred to a specialist hospital and died 1 week later, 3 patients refused to continue participation in the trial. The group to which these excluded patients were allocated is not reported, but it is stated that "[t]he 7 excluded patients provided no bias for or against either treatment group". (pg 109)
Selective reporting (reporting bias) Unclear risk Insufficient information to permit judgement.