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Widely used treatment for head injuries found to be harmful

s after head injury will be reported as soon as these data are available. Many other treatments of uncertain effectiveness for head injury are in widespread use, and further large-scale randomised trials are needed. The CRASH trial has shown that we can enrol many trauma patients into clinical trials in the emergency setting".

In an accompanying commentary (p 1291), Stefan Sauerland (University of Cologne, Germany) concludes: "CRASH partly shakes our pathophysiological understanding of what is of primary importance after traumatic brain injury. The role of inflammatory mediators and the presumed effects of blocking their release must now be elucidated in more detail. Other mechanisms leading to increased intracranial pressure must also be targeted. The key message of CRASH, however, is that applying treatments with unproven effectiveness is like flying blindly. In future, we should avoid trusting in underpowered clinical trials with surrogate rather than clinical endpoints, and transferring evidence from one disease to another".


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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
7-Oct-2004


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