Head-trauma treatment may have killed thousands

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Head-trauma treatment may have killed thousands

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By EMMA ROSS

Associated Press

Friday, October 8, 2004 - Page A17

 

LONDON -- Doctors have been giving steroids to head-trauma patients for

more than 30 years, but the first major study of the practice has shown

steroids are useless and may even have killed thousands of people.

 

Experts said the findings, published today in The Lancet medical

journal, are " a complete and alarming surprise for all. "

 

Head trauma, usually from car crashes, violence or falls, is the leading

cause of death and disability in children and young adults in the

developed world, and globally second only to HIV in causing the death of

people under 40. About three million people die each year from head trauma.

 

Corticosteroids had been used for decades in head trauma patients

because it was believed their anti-inflammatory effects could help bring

down swelling in the brain. However, there was never reliable evidence

steroids helped in cases of severe head injury, and their use has been

controversial.

 

In the mid-1990s, existing evidence indicated they were probably not

effective. Many doctors stopped using them, but not all.

 

The latest study, involving hundreds of doctors in 49 countries treating

more than 10,000 patients, was stopped halfway through recruitment as it

became clear steroids could be harmful.

 

" Most clinicians expected the trial to confirm the benefits of steroids,

while others suspected that the effectiveness of steroids would turn out

to be small or non-existent, " said Dr. Stefan Sauerland and Dr. Marc

Maegele, experts from the University of Witten-Herdecke and the

University of Cologne in Germany. " Instead of a treatment benefit or at

least equality, there were actually 159 excess deaths in the steroid

group, " the experts wrote in an independent critique. " When

extrapolating the results . . . to the annual incidence of severe head

injuries worldwide, it is frightening to calculate how many patients

might have been harmed by steroids. "

 

Dr. Sauerland, who was not connected with the research, estimated

doctors killed about 10,000 head-trauma patients with steroids in the

1980s and earlier.

 

The study, co-ordinated at the London School of Hygiene and Tropical

Medicine, involved 10,008 adults with severe head injuries who were

randomly allocated either a steroid drip or a fake drip for 48 hours

after being admitted to the emergency room.

 

Within two weeks, 21 per cent of the patients given steroids had died,

compared with 18 per cent of those given the fake drug. The results were

the same regardless of how quickly the treatment was administered and

regardless of the type or severity of the head injury.

 

Dr. Ian Roberts, co-ordinator of the trial, said many other treatments

commonly used in trauma patients also were open to question. Approaches

such as hyperventilation, barbiturates and fluid resuscitation have not

been proven to help, he said.

 

" Trauma care has really been the poor relation of medical research, " he

said. " Maybe there are other surprising and alarming results out there.

We don't know. "