Corticosteroids for acute traumatic brain injury
Editorial Group: Cochrane Injuries Group
Published Online: 24 JAN 2005
Assessed as up-to-date: 6 JAN 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 24 JAN 2005
Traumatic brain injury is a leading cause of death and disability. Corticosteroids have been widely used in treating people with traumatic brain injury.
To quantify the effectiveness and safety of corticosteroids in the treatment of acute traumatic brain injury.
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.
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.
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).
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
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.
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。
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).
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。