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.