Intended for healthcare professionals


Corticosteroids in head injury

BMJ 2000; 321 doi: (Published 15 July 2000) Cite this as: BMJ 2000;321:128

It's time for a large simple randomised trial

  1. David Yates, professor,
  2. Ian Roberts, senior lecturer in epidemiology (
  1. Department of Accident and Emergency Medicine, Hope Hospital, Salford M6 8HD
  2. CRASH Trial Coordinating Centre, Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH

    The global epidemic of head injuries is only just beginning. Currently over a million people die each year from brain injuries, and a similar number are disabled, often with profound effects on the quality of their lives.1 Road crashes account for most of the injuries, and car use is rapidly increasing in many countries. By 2020 road crashes will, it is estimated, have moved from ninth to third in the world ranking of disease burden as measured in disability adjusted life years, and second in developing countries.2 Identifying effective treatments for head injury is thus of global health importance.

    Corticosteroids have been used to treat severe head injury for over 30 years, though recently their value has been questioned because of the failure to demonstrate effectiveness in randomised trials.3 Nevertheless, corticosteroids continue to be used widely, albeit inconsistently. Two 1996 British surveys, one of nursing staff in 39 neurosurgical intensive care units and one of medical directors in 44 neurosurgical intensive care units, found that corticosteroids were used to treat head injury in 49% and 14% of units respectively. 4 5

    If a treatment as simple and …

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