Effect of high-dose dexamethasone on outcome from severe head injury

Abstract

The conflicting evidence concerning the influence of high-dose steroids on intracranial pressure (ICP) and outcome following severe head injury has led to the institution of the prospective double-blind controlled trial reported here. Severely head-injured patients admitted to intensive care during a 3-year period were randomly allocated to a dexamethasone- or placebo-treated group. Adults in the steroid group received dexamethasone, 50 mg intravenously, as a bolus on admission to the neurosurgical unit, then 100 mg on Days 1, 2, and 3, 50 mg on Day 4, and 25 mg on Day 5 on continuous intravenous infusion. Children received proportionate intravenous dosages calculated on a weight basis. Severity of head injury was assessed from admission Glasgow Coma Scale (GCS) scores and the appearance of the admission computerized tomography scan. Intracranial pressure (ICP) was monitored in all patients from the surface subarachnoid space. Outcome at 6 months was assessed using the Glasgow Outcome Scale. Steroid and placebo groups were similar in terms of admission GCS score, intracranial pathology, incidence of associated injuries, and time interval from injury to admission to intensive care. The ICP generally increased during the first 48 hours of intensive therapy; there was no difference in this trend between the steroid and placebo groups. A poorer outcome was observed in patients with elevated ICP who received steroids. No increase in the incidence of pulmonary, gastrointestinal, or other extracranial complications was seen in the steroid group. The 6-month outcome did not differ between the steroid and placebo groups. No advantage of high-dose dexamethasone on ICP trends or clinical outcome in the treatment of severe head injury has emerged from this study.

Dexamethasone and colchicine reduce inflammation and delayed oedema following experimental brain contusion

“…Previous investigators have not found a beneficial effect of corticosteroids in brain trauma [6,10] or a diminished inflammation two days after experimental stab wounds [16]. We used a contusional injury instead of a penetrating stab wound and analysed the brains five days after the trauma.…”

Conduta frente à criança com trauma craniano

“…Estudos recentes não mostraram mudanças significantes na mortalidade e morbidade em pacientes tratados com corticóide logo após o trauma craniano. Portanto, a sua utilização não tem benefício comprovado, e a sua indicação não tem sido estimulada 30,31 .…”

Head injury.

“…Numerous trials of steroids at various doses have produced either negative or inconclusive results and one study recorded an adverse effect of steroids in patients with severe head injury with raised ICP 63 64 At present, trials are underway on the effect of various neuroprotective drugs, calcium ion channels or NMDA-type glutamate receptor blocking agents or anti-oxidants acting in the cell membrane. Wbile there is promising information from experimental studies, firm conclusions have not yet been reached on the value of neuroprotective agents in head injured patients.…”