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. 2005 Jan 25;2005(1):CD000196.
doi: 10.1002/14651858.CD000196.pub2.

Corticosteroids for acute traumatic brain injury

P Alderson  1 , I Roberts
Affiliations

Corticosteroids for acute traumatic brain injury

P Alderson et al. Cochrane Database Syst Rev. .

Abstract

Background: Traumatic brain injury is a leading cause of death and disability. Corticosteroids have been widely used in treating people with traumatic brain injury.

Objectives: To quantify the effectiveness and safety of corticosteroids in the treatment of acute traumatic brain injury.

Search strategy: Electronic sources: MEDLINE, EMBASE, Cochrane Library and specialised database searches. Additional hand searching and contact with trialists. Date of the most recent search October 2004.

Selection criteria: All randomised controlled trials of corticosteroid use in acute traumatic brain injury with adequate or unclear allocation concealment.

Data collection and analysis: Quality of allocation concealment was scored. Data on numbers of participants randomised, numbers lost to follow up, length of follow up, case fatality rates, disablement, infections and gastrointestinal bleeds were extracted independently and checked.

Main results: We identified 20 trials with 12303 randomised participants. The effect of corticosteroids on the risk of death was reported in 17 included trials. Due to significant heterogeneity we did not calculate a pooled estimate of the risk of death. The largest trial, with about 80% of all randomised participants, found a significant increase in the risk ratio of death with steroids 1.18 (1.09 to 1.27). For the nine trials that reported death or severe disability, the pooled relative risk was 1.01 (0.91 to 1.11), although this does not yet contain data from the largest trial. For infections the pooled risk ratio from five trials was 1.03 (0.99 to 1.07) and for the ten trials reporting gastrointestinal bleeding 1.23 (0.91 to 1.67).

Authors' conclusions: In the absence of a meta-analysis, we feel most weight should be placed on the result of the largest trial. The increase in mortality with steroids in this trial suggest that steroids should no longer be routinely used in people with traumatic head injury.

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Conflict of interest statement

Ian Roberts collaborated on the design and conduct of the CRASH trial of corticosteroids in head injury, funded by the UK Medical Research Council.

Philip Alderson has no known conflict of interest.

Figures

1.1
1.1. Analysis
Comparison 1 Any steroid administered in any dose against no steroid, Outcome 1 Death at end of follow up period.
1.2
1.2. Analysis
Comparison 1 Any steroid administered in any dose against no steroid, Outcome 2 Death or severe disability at the end of the study period.
1.3
1.3. Analysis
Comparison 1 Any steroid administered in any dose against no steroid, Outcome 3 Infections of any type.
1.4
1.4. Analysis
Comparison 1 Any steroid administered in any dose against no steroid, Outcome 4 Major or significant gastrointestinal bleed.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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