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Gautam, The whole thrust of CRASH is that, whilst individual trials have been less than helpful, meta-analysis of the trials so far available suggests a potential benefit from the use of steroids. The project is being run as a properly financed multi-centre trial, from a cebtre of neurosurgical excellence, with multi-centre ethical committee approval. It will involve giving a bolus of steroids and an infusion of steroids for 48 hours to the treatment group and a double-blind placebo to controls. Entrants will have a head injury with a GCS of less than 15. The role of the defence bodies is to indemnify members. They will also advise, when appropriate. Involvement in a Clinical Trial, provided the usual guidelines are followed, will be covered in the same way as any other clinical matter. As for the current advice, there was a time when bleeding and purging was felt to be the best management - times change, and we must keep seeking the best answer to the questions posed by our patients' clinical problems. It's a bit like Chirs Taylor's post on sitting up or lying down. Leeches are used very effectively by many Plastic Surgery units nowadays, and can be limb-saving -n'est ce pas? Unfortunately, I've left the e-mail address of CRASH at work, but I'll send it on, if you like to contact them directly. Patrick -----Original Message----- From: Gautam Ray <[log in to unmask]> To: [log in to unmask] <[log in to unmask]> Date: 18 October 1998 23:52 Subject: RE: steroids in head injuries >For those of you not on the trauma mailing list, this appeared recently >in answer to a request for information.... > > ------- Forwarded message follows ------- >From: Stuart Baker [mailto:[log in to unmask]] > >Hi! > >Steroids have been shown to not be of benefit in controlling intracranial >pressure or changing outcome in head injuries. They have been suggested by >many to have adverse cerebral metabolic effects in these patients, and make >outcome worse - there is a section on steroids in the American >Neurosurgical Society's guidelines for management of severe head injury. >(end of quote) > >I seem to remember recently seeing a request for collaboration in a >"steroids for head injuries" trial. I think its acronym was CRASH. There >was some discussion in this list, the upshot of which was "don't touch >it with a barge-pole - the MDU/MPS won't back you". I'm intrigued as to >the origins of CRASH, especialy as the evidence seems to be conclusive >enough already against steroids use in HI (see quote above).Is this why >the defence societies are advising against it? Can anyone illuminate me? > > >=========================================================================== > >Dr. Gautam Ray (e-mail: [log in to unmask]) >Sussex, U.K. >--------------------------------------------------------------------------- --- >To err is human, to forgive is not management policy >--------------------------------------------------------------------------- --- %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%