Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months.
MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10,008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96.7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25.7%] vs 1075 [22.3%] deaths; relative risk 1.15, 95% CI 1.07-1.24; p=0.0001), as was the risk of death or severe disability (1828 [38.1%] vs 1728 [36.3%] dead or severely disabled; 1.05, 0.99-1.10; p=0.079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.
Edwards
Phil
P
Arango
Miguel
M
Balica
Laura
L
Cottingham
Rowland
R
El-Sayed
Hesham
H
Farrell
Barbara
B
Fernandes
Janice
J
Gogichaisvili
Tamar
T
Golden
Nyoman
N
Hartzenberg
Bennie
B
Husain
Mazhar
M
Ulloa
Mario Izurieta
MI
Jerbi
Zouheir
Z
Khamis
Hussein
H
Komolafe
Edward
E
Laloë
Véronique
V
Lomas
Gabrielle
G
Ludwig
Silke
S
Mazairac
Guy
G
Muñoz Sanchéz
Maria de los Angeles
Mde L
Nasi
Luis
L
Olldashi
Fatos
F
Plunkett
Patrick
P
Roberts
Ian
I
Sandercock
Peter
P
Shakur
Haleema
H
Soler
Caridad
C
Stocker
Reto
R
Svoboda
Petr
P
Trenkler
Stefan
S
Venkataramana
N K
NK
Wasserberg
Jonathan
J
Yates
David
D
Yutthakasemsunt
Surakrant
S
D006259:Craniocerebral Trauma / Q000188:drug therapy* / Q000401:mortality; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008775:Methylprednisolone / Q000008:administration & dosage*; D012307:Risk Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D008775:Methylprednisolone