Corticosteroids in head injury

It's time for a large simple randomised trial

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 …