A previous review found there was not enough evidence to recommend that routine use of steroids be stopped. This newer analysis draws heavily from a recent study of corticosteroid treatment for brain injury, including coma and concussion, that included 10,008 patients, more than all similar studies combined.
The large study found that patients treated with corticosteroids were 18 percent more likely to die from their brain injury than those who did not take the drugs. Among the patients who received steroid treatment, 21 percent died, compared to 18 percent who received a placebo.
"The significant increase in death with steroids found in this trial suggests that steroids should no longer be routinely used in people with traumatic head injury,” says Dr. Phil Alderson, lead author of the study published by the Cochrane Collaboration. "It is thought that some of the damage after a brain injury results from inflammation following the initial injury and that reducing inflammation might reduce this secondary injury.”
In the case of severe head injuries, the inflammation leads to swelling of the brain and its surrounding tissues, which in turns creates pressure in the skull that may lead to complications or death.
The cause of death in patients who received steroid treatment in the new large trial was unclear, according the study's authors. Some researchers have suggested that corticosteroids increase the likelihood of death by interfering with adrenal gland function.
Steroid use did not reduce the risks of infection among these patients, the authors concluded. Gastrointestinal bleeding complications did not seem to increase or decrease with steroid treatment.
MEDICA.de; Source: The Cochrane Collaboration