Steroids increase death risk from traumatic head injury

The common use of anti-inflammatory steroids for traumatic head injuries like those from car crashes may actually increase the risk of death, according to a new review of studies about the treatment.1

A previous review found there was not enough evidence to recommend that routine use of steroids be stopped. This newer analysis published by the British-based Cochrane Library 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 ,or 1,052 of the 4,985 treated, 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 Cochrane study.

The review appears in the January issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Corticosteroids are anti-inflammatory hormones used to treat all kinds of inflammation, from joint injury to asthma. They differ from anabolic steroids, the sex hormones like androgen, which are typically used to increase muscle mass and improve athletic performance. Corticosteroids are “widely used in medicine to treat inflammation,” Alderson explains. “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 17 studies on steroid use and the risk of death examined by Alderson and colleagues included a total of 12,083 patients of all ages with clinically diagnosed traumatic brain injury, some of whom received steroid treatment within seven days of their injury.

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. Not all physicians routinely prescribe corticosteroids, Alderson says, but he notes that use of the drugs “was quite widespread,” when The Cochrane Collaboration first reviewed the treatment in 1997.

A 2000 survey of brain trauma treatment centers in the United States found that one-third of those centers still use corticosteroids routinely, according Jamshid Ghajar, president of The Brain Trauma Foundation, which conducted the survey. According to the U.S. Centers for Disease Control and Prevention, 1.4 million American suffer traumatic brain injuries a year, and 50,000 die from it. “Since this often occurs in young people and is long term, traumatic brain injury-related disability is a major cause of ill health worldwide,” Alderson says.

1. Alderson et al. Corticosteriods for acute traumatic brain injury. The Cochrane Database of Systematic Reviews 2005, Issue 1