Trial of steroids for treating head injury begins

A major international trial has been launched to determine whether the delivery of cortico-steroids shortly after head injury can reduce deaths and disability after accidents.

Corticosteroid randomisation after significant head injury (CRASH) is an international, multicentre trial, in which 20000 people with a recent head injury and impaired consciousness will be randomised to receive a 48 hour infusion of corticosteroids or placebo. The trial, supported by the Medical Research Council, will include 63 centres in the United Kingdom, the Czech Republic, Italy, Ireland, Germany, and Switzerland.

Although corticosteroids have been used in some centres for severe head injury for the past 20 years, results of trials have been inconclusive. Combined results of these studies point to a reduced risk of death among treated patients of about 2%but the 95%confidence interval runs from 6%lower to 2%higher mortality, indicating that treatment may be beneficial or even slightly hazardous.

“The CRASH trial will determine reliably the effects on death and on disability of short term corticosteroid infusion following significant head injury,” said Dr Ian Roberts, clinical coordinator of CRASH. “If corticosteroids can reduce the risk of death and neurological damage by 2%then this is substantial considering the number of people who are killed and permanently disabled through head injury each year.”

Interest in the role of corticosteroids in preventing neurological damage has been renewed after encouraging results in people with spinal cord injuries, such as the American actor Christopher Reeve. A short course of corticosteroids given shortly after injury is thought to prevent post-traumatic neuronal degeneration. “Some brain damage occurs at the time of injury, and it continues. This regimen is believed to prevent the ongoing process,” said Dr Roberts.

Further information is available from CRASH Coordinating Centre, 30 Guilford Street, London WC1N 1EH (tel: 0171 242 2092; email: CRASH{at}ich.ucl.ac.uk website: www.crash.ucl.ac.uk)

crash will investigate the use of steroids in treating head injury