• Effect of Intravenous Corticosteroids on Death within 14 days in 10008 Adults with Clinically Significant Head Injury (MRC CRASH trial): Randomised Placebo-Controlled Trial

    Effect of Intravenous Corticosteroids on Death within 14 days in 10008 Adults with Clinically Significant Head Injury (MRC CRASH trial): Randomised Placebo-Controlled Trial.

    Summary:

    • Corticosteroids have been used in the treatment of traumatic brain injury for decades, however previous studies have been limited by small sample size
    • The CRASH trial is a multicenter RCT where 10,008 adults (age 16 or older) within 8 hours of head injury with GCS 14 or less were allocated to either receive 48 hours of corticosteroids or a placebo
    • Patients in the treatment arm were given a loading does of 2g methylprednisolone then maintained on 0.4g methylprednisolone per hour for 48 hours.
    • Primary outcomes were death from any cause within in 2 weeks and death or disability at 6 months
    • All analysis was completed on an intention to treat basis, final results included patients from 239 hospitals in 49 different countries
    • Compared with placebo, risk of death from all causes within two weeks was higher in the corticosteroid group regardless of time since initial injury or severity of initial injury
    • At 6 month follow up, there was again increased risk of death in the corticosteroid group
    • Corticosteroid should not be used routinely to treat head injury 

    Roberts I, Yates D, Sandercock P, Farrell B, Wasserberg J, Lomas G, Cottingham R, Svoboda P, Brayley N, Mazairac G, Laloë V, Muñoz-Sánchez A, Arango M, Hartzenberg B, Khamis H, Yutthakasemsunt S, Komolafe E, Olldashi F, Yadav Y, Murillo-Cabezas F, Shakur H, Edwards P; CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet. 2004 Oct 9-15;364(9442):1321-8. doi: 10.1016/S0140-6736(04)17188-2. PMID: 15474134.

    Edwards P, Arango M, Balica L, Cottingham R, El-Sayed H, Farrell B, Fernandes J, Gogichaisvili T, Golden N, Hartzenberg B, Husain M, Ulloa MI, Jerbi Z, Khamis H, Komolafe E, Laloë V, Lomas G, Ludwig S, Mazairac G, Muñoz Sanchéz Mde L, Nasi L, Olldashi F, Plunkett P, Roberts I, Sandercock P, Shakur H, Soler C, Stocker R, Svoboda P, Trenkler S, Venkataramana NK, Wasserberg J, Yates D, Yutthakasemsunt S; CRASH trial collaborators. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet. 2005 Jun 4-10;365(9475):1957-9. doi: 10.1016/S0140-6736(05)66552-X. PMID: 15936423.

    This summary was originally published in Nov. 2021.

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