Dexamethasone and severe head injury

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Abstract
A prospective double-blind study of the effects of dexamethasone administration on the outcome of patients with severe head injuries was performed. Patients were stratified for severity of neurological injury and were treated with placebo, low-dose dexamethasone (16 mg/day) or high-dose dexamethasone (96 mg/day) for of 6 days. Outcome was evaluated at 6 mo. after injury. Of the 76 patients available for analysis, a good outcome was achieved in 37% of placebo-treated patients, 44% of low-dose-treated patients and 29% of high-dose-treated patients. These differences are not statistically significant. Similarly dexamethasone administration had no statistically significant effect on intracranial pressure patterns or serial neurological examinations during hospitilization. Gastrointestinal bleeding occurred in only 1 patient. Good outcome was associated with age under 10 yr, lighter depth of coma on admission and the preservation of brain-stem reflexes upon admission. A recalculation of data in previous clinical series purporting to show an improvement in outcome due to corticosteroid therapy shows no significant difference in outcome when steroid- and placebo-treated patients are compared. Of all deaths, 90% were caused by recurrent intracranial hematomas, medical complications or diffuse brain injuries with parenchymal hemorrhage and tissue disruption, causes of death which cannot be affected by corticosteroid therapy. Apparently dexamethasone in either high or low dosages has no significant effect on morbidity and mortality after severe head injury.
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