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The World in Medicine
November 17, 2004

Caution on Head Injury Rx

JAMA. 2004;292(19):2329. doi:10.1001/jama.292.19.2329-a

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.

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