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Corticosteroids for acute traumatic brain injury

  1. Phil Alderson1,*,
  2. Ian Roberts2

Editorial Group: Cochrane Injuries Group

Published Online: 24 JAN 2005

Assessed as up-to-date: 6 JAN 2008

DOI: 10.1002/14651858.CD000196.pub2


How to Cite

Alderson P, Roberts I. Corticosteroids for acute traumatic brain injury. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD000196. DOI: 10.1002/14651858.CD000196.pub2.

Author Information

  1. 1

    National Institute for Health and Clinical Excellence, Manchester, UK

  2. 2

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

*Phil Alderson, National Institute for Health and Clinical Excellence, Level 1A, City Tower,, Piccadilly Plaza, Manchester, M1 4BD, UK. Philip.Alderson@nice.org.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 24 JAN 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Traumatic brain injury is a leading cause of death and disability. Corticosteroids have been widely used in treating people with traumatic brain injury.

Objectives

To quantify the effectiveness and safety of corticosteroids in the treatment of acute traumatic brain injury.

Search methods

We searched: CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (Ovid SP), PubMed [www.ncbi.nlm.nih.gov/sites/entrez/], EMBASE (Ovid SP) and PsycINFO (Ovid SP). The searches were last updated in January 2008.

Selection criteria

All randomised controlled trials of corticosteroid use in acute traumatic brain injury with adequate or unclear allocation concealment.

Data collection and analysis

Both authors independently scored quality of allocation concealment. Study authors were contacted for additional information. One author independently extracted data on numbers of participants randomised, numbers lost to follow up, length of follow up, case fatality rates, disablement, infections and gastrointestinal bleeds and this was checked by the other author.

Main results

We identified 20 trials with 12,303 randomised participants. The effect of corticosteroids on the risk of death was reported in 17 included trials. Due to significant heterogeneity we did not calculate a pooled estimate of the risk of death. The largest trial, with about 80% of all randomised participants, found a significant increase in the risk ratio of death with steroids 1.15 (95% CI 1.07 to 1.24) and a relative risk of death or severe disability of 1.05 (95% CI 0.99 to 1.10). For infections the pooled risk ratio from five trials was 1.03 (95% CI 0.99 to 1.07) and for the ten trials reporting gastrointestinal bleeding 1.23 (95% CI 0.91 to 1.67).

Authors' conclusions

In the absence of a meta-analysis, we feel most weight should be placed on the result of the largest trial. The increase in mortality with steroids in this trial suggest that steroids should no longer be routinely used in people with traumatic head injury.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Corticosteroids to treat brain injury

Traumatic brain injury is a leading cause of death and disability. After the injury the brain may swell, causing a potentially fatal condition called raised intracranial pressure (ICP). Corticosteroid drugs have been widely used, for many years, to treat patients with brain injury because they are thought to reduce intracranial pressure. Some examples of corticosteroids are dexamethasone and methylprednisolone.

The review authors searched the medical literature to determine how effective and safe corticosteroids are for treating brain injury. They focused their search on randomised controlled trials in which one group of people received a medical treatment (corticosteroids) and was compared with a similar group who received a different treatment or no treatment other than standard care. The review authors found 20 of these studies with 12,303 participants. When the review was first done the results of the research were inconclusive. A new large study with about 80% of the total participants was completed by the time of the 2006 update of this review. This study, called CRASH, showed a significant increase in number of deaths in patients given steroids compared with patients who received no treatment. The significant increase in deaths with steroids suggests that steroids should no longer be routinely used in people with traumatic head injury.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

類固醇治療急性創傷性大腦損傷

急性創傷性大腦損傷是死亡和生理殘障的主要原因。類固醇已經被廣泛地使用在急性創傷性大腦損傷病患。

目標

定量出類固醇在治療急性創傷性大腦損傷的效力和安全性。

搜尋策略

我們搜尋Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE (January 1966 to November 2005), EMBASE (Janurary 1985 to November 2005),與專業的資料庫.額外手動搜尋並與試驗者接觸。

選擇標準

所有類固醇治療急性創傷性大腦損傷的隨機控制試驗,無論足夠或者不清楚分配隱藏的研究。

資料收集與分析

兩名作者獨立評比分配隱密性的品質,研究作者被額外的訊息聯繫,另一名作者獨立隨機選出關於參加者的數據, 失去追蹤的數目,追蹤的時間長度,死亡率,喪失工作能力,感染和胃腸出血。這些被其它作者檢查。

主要結論

我們選出20個試驗共12303個隨機參加者。17個試驗報告出類固醇對死亡風險的影響。由於明顯的非均勻性,我們並沒有計算出集中的死亡風險估計。最大的試驗, 占大約全部隨機參加者80%,發現類固醇會顯著增加死亡風險比率1.15(95%的CI 1.07 to 1.24),增加死亡相關風險或嚴重的生理殘障比率1.05(95%的CI 0.99 to 1.10). 對感染來說,來自5 次試驗報告,集中的風險比率是1.03(95%的CI 0.99 to 1.07),10 次試驗報告胃腸出血的風險比率是1.23(95%的CI 0.91 to 1.67).

作者結論

缺乏一個綜合分析的情況下,我們應重視最大的試驗報告結果。在這次試驗結果的過程中,類固醇會增加死亡率,建議類固醇不要被常規使用於急性創傷性大腦損傷。

翻譯人

本摘要由高雄榮民總醫院葉宣德翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

用類固醇治療急性創傷性大腦損傷是導致死亡和生理殘障的主要原因。大腦損傷後會腫脹,引起潛在致命的顱內壓升高(IICP)。類固醇治療急性創傷性大腦損傷已經被廣泛地使用多年,因為他們被認為可降低顱內壓。關於dexamethasone和methylprednisolone,作者搜尋醫學文獻確定類固醇治療創傷性大腦損傷的效果和安全。他們的搜尋聚焦在隨機控制試驗上:一群人們接受類固醇治療,比較接受不同治療或者未接受治療處理的另一群人。回顧作者發現20個研究試驗共12303個參加者。當回顧被首先做時,研究的結果是不確定的。這篇回顧截至2006 更新,包含大約80%參加者的一項新的大型研究被完成。這項研究叫CRASH,相較於未接受治療處理,給類固醇治療明顯地增加病患死亡率。類固醇會增加死亡率,建議類固醇不要被常規使用於急性創傷性大腦損傷。