Methylprednisolone was associated with an increase in death after head injury
Q In patients with head injury, is early administration of methylprednisolone better than placebo for reducing death?
METHODS
Design:
randomised placebo controlled trial (Corticosteroid Randomisation After Significant Head injury [CRASH]).
Allocation:
concealed.
Blinding:
blinded (clinicians and patients).
Follow up period:
2 weeks.
Setting:
239 hospitals in 49 countries.
Patients:
10 008 patients who were ⩾16 years of age (mean age 37 y, 81% men) and had sustained a head injury within 8 hours, had a Glasgow Coma Score (GCS) ⩽14, and whose treating physician was uncertain whether to treat with corticosteroids.
Intervention:
a loading dose of methylprednisolone, 2 g over 1 hour in a 100 ml infusion, followed up by a maintenance infusion of 0.4 g over 48 hours in a 20 ml/h infusion (n = 5007) or placebo (n = 5001).
Outcomes:
all cause mortality. Recruitment was planned for 20 000 …
