Thursday, October 07, 2004

Steroids increase head injury death rate by about 15%

Study: Steroids useless for head injury
The study, coordinated at the London School of Hygiene & Tropical Medicine, involved 10,008 adults with severe head injuries who were randomly given either a steroid drip or a placebo for 48 hours after being admitted to the emergency room.

Within two weeks, 21 percent of the patients given steroids had died, compared with 18 percent of those given the placebo. The results were the same regardless of how quickly the treatment was given and regardless of the type or severity of the head injury.

The steroids may or may not have helped with brain swelling, but they are toxic and dangerous drugs. The net effect appears to have been quite harmful.

Once again we see the limitations of retrospective studies. Only a large randomized trial was able to expose this problem. This is very reminescent of the estrogen replacement therapy crisis, though here the harm seems greater (ERT therapy was only slightly more harmful than no therapy).

I'm left with a bad feeling about the basis of a lot of interventions that have been shown in smaller or retrospective studies to improve mortality by 10-25%. A LOT of our medical and surgical interventions have benefits in that range. I think we need to consider them all to be highly suspect.

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