The CRASH TRIAL

Summary by Mana Mathieu MD, 04.04.22

https://pubmed.ncbi.nlm.nih.gov/15474134/

Randomized control trial investigating the use of Corticosteroid Randomization After Significant Head Injury (CRASH)

Take Home Point:

  • Ongoing debate on the use of high-dose ethylprednisolone early in ASCI.

Summary

  • CRASH: corticosteroid randomization after significant head injury ( large, international, randomized placebo-controlled trial of the effect of early administration of 48h infusion of methylprednisolone on risk of death and disability after head injury.

  • Intro: Corticosteroids have been used worldwide to treat head injury.

  • Methods: Randomized 10,008 adult patients (within 8 hours of head injury and GCS of 14 or less) received 48 hour infusion of methylprednisolone or placebo. Primary outcome was death from any cause within 2 weeks of injury.

  • Results: Corticosteroids group had higher risk of death when compared to placebo. This was seen across various injury severities and times since injury.

  • Discussion: Methylprednisolone did not show a reduction in mortality when given within two weeks after head injury. The cause of the rise in risk of death for within 2 weeks is unclear.

  • Limitation: Multiple uncontrolled factors in trauma that impact mortality.