CRASH

Worldwide, millions of people are treated each year for severe head injury. A substantial proportion die, and many more are permanently disabled. If short-term corticosteroid infusion could be reliably shown to reduce these risks by just a few percent then this might affect the treatment of a few hundred thousand patients a year, protecting thousands from death or long term disability.

When all previous trials of steroids in head injury were combined, the risk of death in the corticosteroid treated group appeared to be about 2% lower than in the control group, but the 95% confidence interval ran from 6% lower to 2% higher mortality. Thus, the overall result was compatible with there being no benefit, but was also easily compatible with a benefit of a few percent.

The CRASH Trial determined reliably the effects on death and on disability of a short-term corticosteroid infusion following significant head injury. The trial found no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lent support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.