A standard treatment used on patients with head injury has been found to do more harm than good, according to major research published today.
The CRASH (corticosteroids randomisation after significant head injury) trial, which included more than 100 Irish patients, found 21 per cent of people prescribed steroid treatment after head injury died within two weeks compared with 18 per cent of those given a placebo (dummy) treatment.
Patients with an acute head injury can develop increased pressure in the skull following trauma. The pressure can lead to a critical reduction in blood flow to the brain and fatal pressure on the brain stem. It had been thought that steroids, the most powerful anti-inflammatory drugs available, would reduce swelling and pressure, and reduce the risk of death and disability following head injury.
An editorial in the Lancet, which published the research, says the routine administration of steroids to brain-injured patients may have caused more than 10,000 deaths worldwide until the 1990s. This is because giving steroids to patients with a head injury had been standard treatment for 30 years.
Dr Patrick Plunkett, clinical director of emergency medicine at St James's hospital, Dublin, who co-authored the Irish arm of the study, said the results were a major surprise.
"This study finally answers a difficult question which has previously had doctors responsible for head-injury care divided into those who believe corticosteroids help and those who do not.
"Head injury kills and maims many people in our society - finding the actual effects of a significant treatment is critical to our efforts to improve the outcome for those patients and their families."
The CRASH trial involved over 10,000 patients from 239 hospitals in 49 countries. Some 113 patients with head injury who presented to the A&E department of St James's Hospital in the last three years were enrolled in the trial. All received an intravenous drip for 48 hours after admission without the doctors being aware whether the drip included a steroid or a dummy solution.
It was originally intended to recruit more than 20,000 patients, but the trial was stopped when the co-ordinators realised that giving steroids was actually causing additional deaths.
Every year, one in five people with head injury die and many are permanently disabled. Dr Ian Roberts, of the London School of Hygiene and Tropical Medicine who co-ordinated the study, said: "Obviously we'd have preferred to find that steroids improved patients' chance of surviving head injury, but our results are important because they will improve patient care and protect thousands of future patients from increased risk of death from steroids."
The impact of steroids on disability among head-injury patients is still being investigated by the researchers, who expect to publish a follow-up report.