Corticosteroids have been used to treat head injuries for more than 30 years. Last year, the CRASH trial, involving 10,000 adults with head injury, found that treatment with corticosteroids increased the risk of death at two weeks when compared with a placebo. (Lancet 2004; 364: 1321-28) In this final 6-month follow-up the CRASH trial investigators found the risk of death or severe disability was also higher in the corticosteroid group than in the placebo group.
Dr Edwards comments: "Our results show that corticosteroids which have been used to treat head injuries for decades may be harmful. Corticosteroids are also used to treat spinal cord injury and given the CRASH trial results this practice should be urgently re-evaluated. Other widely used treatments for head injuries should also be properly evaluated in large-scale trials. The longstanding neglect of trauma care research is a scandal and patients are dying needlessly as a result of it." (Quote by e-mail; does not appear in published paper)
Contact: Dr Phil Edwards, CRASH trials Co-ordinating Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. T) +44 (0)20 7958 8112 or +44 (0) 7966 273462 phil.edwards@LSHTM.ac.uk
The Lancet