The common practice of treating patients with severe head injuries with
corticosteroids is dangerous and associated with a substantial increase in
death within 2 weeks of hospital admission, according to a large international
study (Lancet. 2004;364:1321-1328).
The rationale for the treatment was the belief that posttraumatic inflammation
contributes to neuronal degeneration. But previous trials supporting its use
were relatively small and a 1997 systematic review suggested that the drugs
might reduce risk of death only slightly. To provide more definitive answers,
researchers launched the CRASH (Corticosteroid Randomisation After Significant
Head Injury) trial, enrolling about 10 000 patients to receive methylprednisolone
or placebo for 48 hours after admission to a hospital emergency department.
Stephenson J. Caution on Head Injury Rx. JAMA. 2004;292(19):2329. doi:10.1001/jama.292.19.2329-a