Steroids Risky Treatment for Brain Injury

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Steroid medications commonly used to reduce inflammation caused by traumatic head injuries may actually boost the risk of death, a new report suggests.

British researchers evaluated the results of more than 10,000 patients with brain injury. They found that those treated with corticosteroids after traumatic Head injury were more likely to die from the injury than those who did not take the drugs.

Among those who received steroid treatment, 21 percent—or 1,052 of the 4,985 patients treated—died, the authors reported, compared to 18 percent who received a placebo.

“There is a 3 percent absolute increase in the risk of death such that 21 percent of patients die with steroids and 18 percent die without,” said lead researcher Dr. Ian Roberts, a professor of epidemiology at the London School of Hygiene & Tropical Medicine.

Corticosteroids are hormones used to treat inflammation, whether it results from asthma or joint injury or other conditions.

Roberts and his colleagues looked at 17 studies on steroid use. They noted that corticosteroid use is widespread after serious brain injury. An estimated 1.4 million Americans suffer traumatic brain injuries each year, according to the U.S. Centers for Disease Control and Prevention, and 50,000 die from the injuries.

The report appears in the current issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

While it’s not certain why corticosteroids may boost death risk, some experts have suggested the drugs may somehow interfere with the function of the adrenal glands. They are located on top of the kidneys and produce hormones such as cortisone, cortisol and adrenalin.

Dr. Wally Ghurabi, medical director of the emergency center at Santa Monica-UCLA Medical Center, called the new study “an eye-opener.”

At his institution, he said, “we use very little” corticosteroids for Head injury patients. And, he noted, when they are used, the corticosteroids are given in small doses, a fraction of what was used in some of the studies reviewed. “I question the use of megadoses,” Ghurabi said.

Roberts said the study would inevitably change the way physicians think about and treat Head injury.

Each year, about 1.1 million of the 1.4 million Americans who suffer a traumatic brain injury—such as a concussion—are treated at hospitals and released, according to the CDC. Falls are the leading cause of these brain injuries, but car accidents are another cause.

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