title: Calcium channel blockers for acute traumatic brain injury.
abstract: BACKGROUND
  Acute traumatic brain injury is a major cause of death and disability. Calcium channel blockers have been used in an attempt to prevent cerebral vasospasm after injury, maintain blood flow to the brain and so prevent further damage.
  
  
  OBJECTIVE
  To estimate the effects of calcium channel blockers in patients with acute traumatic brain injury and in a subgroup of brain injury patients with traumatic subarachnoid haemorrhage.
  
  
  METHODS
  Hand searching and electronic searching for randomized controlled trials available by October 1997.
  
  
  METHODS
  Randomized controlled trials in patients with all levels of severity of clinically diagnosed acute traumatic brain injury.
  
  
  METHODS
  Two reviewers (JL and CG) independently assessed the identified studies for eligibility and extracted data from each study. Summary odds ratios were calculated using the Mantel-Haenszel method.
  
  
  RESULTS
  Four RCTs were identified as eligible for inclusion in the systematic review. The effect of calcium channel blockers on the risk of death was reported in all RCTs. The pooled odds ratio for the four studies was 0.91 (95% confidence interval 0. 70 to 1.17). For the three RCTs that reported death and severe disability the pooled odds ratio was 0.85 (95% CI 0.68 to 1.07). In the two RCTs which reported the risk of death in a sub group of traumatic subarachnoid haemorrhage patients, the pooled odds ratio was 0.59 (95% CI 0.37 to 0.94). Three RCTs reported death and severe disability as an outcome in this subgroup, and the pooled odds ratio was 0.67 (95% CI 0.46 to 0.98).
  
  
  CONCLUSIONS
  This systematic review of randomized controlled trials of calcium channel blockers in acute traumatic head injury patients shows that considerable uncertainty remains over their effects. The effect of nimodipine in a subgroup of brain injury patients with subarachnoid haemorrhage shows a beneficial effect, though the increase in adverse reactions suffered by the intervention group may mean that the drug is harmful for some patients.
authors.affiliation: R&D Public Health, Kensington, Chelsea and Westminster Health Authority, 50 Eastbourne Terrace, London, UK, W2 6LX. julia.langham@ha.kcw-ha.nthames.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Langham
authors.forename: C
authors.initials: C
authors.lastname: Goldfrad
authors.forename: G
authors.initials: G
authors.lastname: Teasdale
authors.forename: D
authors.initials: D
authors.lastname: Shaw
authors.forename: K
authors.initials: K
authors.lastname: Rowan
mesh_terms: D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006801:Humans; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control*
chemical_list: D002121:Calcium Channel Blockers