Steroids increase death risk from traumatic h...( ondary injury. In the case of se...),Health

In the case of severe head injuries, the inflammation leads to swelling of the brain and its surrounding tissues, which in turns creates pressure in the skull that may lead to complications or death.

The 17 studies on steroid use and the risk of death examined by Alderson and colleagues included a total of 12,083 patients of all ages with clinically diagnosed traumatic brain injury, some of whom received steroid treatment within seven days of their injury.

The cause of death in patients who received steroid treatment in the new large trial was unclear, according the study's authors. Some researchers have suggested that corticosteroids increase the likelihood of death by interfering with adrenal gland function.

Steroid use did not reduce the risks of infection among these patients, the authors concluded. Gastrointestinal bleeding complications did not seem to increase or decrease with steroid treatment.

Not all physicians routinely prescribe corticosteroids, Alderson says, but he notes that use of the drugs "was quite widespread," when The Cochrane Collaboration first reviewed the treatment in 1997.

A 2000 survey of brain trauma treatment centers in the United States found that one-third of those centers still use corticosteroids routinely, according Jamshid Ghajar, president of The Brain Trauma Foundation, which conducted the survey.

According to the U.S. Centers for Disease Control and Prevention, 1.4 million American suffer traumatic brain injuries a year, and 50,000 die from it.

"Since this often occurs in young people and is long term, traumatic brain injury-related disability is a major cause of ill health worldwide," Alderson says.

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Contact: Phil Alderson
palderson@cochrane.co.uk
Center for the Advancement of Health
23-Jan-2005