Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury - outcomes at 6 months

Colin Baigent; Michael Bracken; David Chadwick; Kevin Curley; Lelia Duley; Barbara Farrell; Marcel Haegi; Gabrielle Lomas; Graham Nickson; Richard Peto; John Pickard; Ian Roberts; Peter Sandercock; Graham Teasdale; Jonathan Wasserberg; David Yates; Rory Collins; Stephen Haines; Stephen MacMahon; Charles Warlow; Phil Edwards; Arbara Farrell; Gabrielle Lomas; Nin Ritchie; Ian Roberts; Peter Sandercock; Aleema Shakur; Graham Teasdale; Jonathan Wasserberg; David Yates; Haleema Shakur; Ian Roberts; Phil Edwards; Maria Ramos; Lin Barnetson; Janice Fernandes; Donna Tooth; Cari Free; Leena Narayanan; Johan Collander; Julia Abernethy; Josephine Bardswell; Nin Ritchie; Reshma Mashru; Catherine Godward; Elizabeth Afolabi; Adrian Ritchie; Tessa Hosford; Shiela Pantrini; Sheila Massey; Amber Collingwood; Phil Edwards; Miguel Arango; Laura Balica; Rowland Cottingham; Hesham El-Sayed; Barbara Farrell; Janice Fernandes; Tamar Gogichaisvili; Nyoman Golden; Bennie Hartzenberg; Mazhar Husain; Mario Izurieta Ulloa; Zouheir Jerbi; Hussein Khamis; Edward Komolafe; Véronique Laloë; Gabrielle Lomas; Silke Ludwig; Guy Mazairac; Maria De Los Angeles Muñoz Sanchéz; Luis Nasi; Fatos Olldashi; Patrick Plunkett; Ian Roberts; Peter Sandercock; Haleema Shakur; Caridad Soler; Reto Stocker; Petr Svoboda; Stefan Trenkler; N. K. Venkataramana; Jonathan Wasserberg; David Yates; Surakrant Yutthakasemsunt

doi:10.1016/S0140-6736(05)66552-X

Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury - outcomes at 6 months

Colin Baigent, Michael Bracken, David Chadwick, Kevin Curley, Lelia Duley, Barbara Farrell, Marcel Haegi, Gabrielle Lomas, Graham Nickson, Richard Peto, John Pickard, Ian Roberts, Peter Sandercock, Graham Teasdale, Jonathan Wasserberg, David Yates, Rory Collins, Stephen Haines, Stephen MacMahon, Charles WarlowPhil Edwards, Arbara Farrell, Gabrielle Lomas, Nin Ritchie, Ian Roberts, Peter Sandercock, Aleema Shakur, Graham Teasdale, Jonathan Wasserberg, David Yates, Haleema Shakur, Ian Roberts, Phil Edwards, Maria Ramos, Lin Barnetson, Janice Fernandes, Donna Tooth, Cari Free, Leena Narayanan, Johan Collander, Julia Abernethy, Josephine Bardswell, Nin Ritchie, Reshma Mashru, Catherine Godward, Elizabeth Afolabi, Adrian Ritchie, Tessa Hosford, Shiela Pantrini, Sheila Massey, Amber Collingwood, Phil Edwards, Miguel Arango, Laura Balica, Rowland Cottingham, Hesham El-Sayed, Barbara Farrell, Janice Fernandes, Tamar Gogichaisvili, Nyoman Golden, Bennie Hartzenberg, Mazhar Husain, Mario Izurieta Ulloa, Zouheir Jerbi, Hussein Khamis, Edward Komolafe, Véronique Laloë, Gabrielle Lomas, Silke Ludwig, Guy Mazairac, Maria De Los Angeles Muñoz Sanchéz, Luis Nasi, Fatos Olldashi, Patrick Plunkett, Ian Roberts, Peter Sandercock, Haleema Shakur, Caridad Soler, Reto Stocker, Petr Svoboda, Stefan Trenkler, N. K. Venkataramana, Jonathan Wasserberg, David Yates, Surakrant Yutthakasemsunt

Neurosurgery

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Abstract

MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10 008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96 7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25 7%] vs 1075 [22 3%] deaths; relative risk 1 15, 95% CI 1 07-1 24; p=0 0001), as was the risk of death or severe disability (1828 [38 1%] vs 1728 [36 3%] dead or severely disabled; 1 05, 0 99-1 10; p=0 079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.

Original language	English (US)
Pages (from-to)	1957-1959
Number of pages	3
Journal	The Lancet
Volume	365
Issue number	9475
DOIs	https://doi.org/10.1016/S0140-6736(05)66552-X
State	Published - Jun 4 2005

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Baigent, C., Bracken, M., Chadwick, D., Curley, K., Duley, L., Farrell, B., Haegi, M., Lomas, G., Nickson, G., Peto, R., Pickard, J., Roberts, I., Sandercock, P., Teasdale, G., Wasserberg, J., Yates, D., Collins, R., Haines, S., MacMahon, S., ... Yutthakasemsunt, S. (2005). Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury - outcomes at 6 months. The Lancet, 365(9475), 1957-1959. https://doi.org/10.1016/S0140-6736(05)66552-X

Baigent, C, Bracken, M, Chadwick, D, Curley, K, Duley, L, Farrell, B, Haegi, M, Lomas, G, Nickson, G, Peto, R, Pickard, J, Roberts, I, Sandercock, P, Teasdale, G, Wasserberg, J, Yates, D, Collins, R, Haines, S, MacMahon, S, Warlow, C, Edwards, P, Farrell, A, Lomas, G, Ritchie, N, Roberts, I, Sandercock, P, Shakur, A, Teasdale, G, Wasserberg, J, Yates, D, Shakur, H, Roberts, I, Edwards, P, Ramos, M, Barnetson, L, Fernandes, J, Tooth, D, Free, C, Narayanan, L, Collander, J, Abernethy, J, Bardswell, J, Ritchie, N, Mashru, R, Godward, C, Afolabi, E, Ritchie, A, Hosford, T, Pantrini, S, Massey, S, Collingwood, A, Edwards, P, Arango, M, Balica, L, Cottingham, R, El-Sayed, H, Farrell, B, Fernandes, J, Gogichaisvili, T, Golden, N, Hartzenberg, B, Husain, M, Ulloa, MI, Jerbi, Z, Khamis, H, Komolafe, E, Laloë, V, Lomas, G, Ludwig, S, Mazairac, G, De Los Angeles Muñoz Sanchéz, M, Nasi, L, Olldashi, F, Plunkett, P, Roberts, I, Sandercock, P, Shakur, H, Soler, C, Stocker, R, Svoboda, P, Trenkler, S, Venkataramana, NK, Wasserberg, J, Yates, D & Yutthakasemsunt, S 2005, 'Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury - outcomes at 6 months', The Lancet, vol. 365, no. 9475, pp. 1957-1959. https://doi.org/10.1016/S0140-6736(05)66552-X

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abstract = "MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10 008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96 7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25 7%] vs 1075 [22 3%] deaths; relative risk 1 15, 95% CI 1 07-1 24; p=0 0001), as was the risk of death or severe disability (1828 [38 1%] vs 1728 [36 3%] dead or severely disabled; 1 05, 0 99-1 10; p=0 079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.",

author = "Colin Baigent and Michael Bracken and David Chadwick and Kevin Curley and Lelia Duley and Barbara Farrell and Marcel Haegi and Gabrielle Lomas and Graham Nickson and Richard Peto and John Pickard and Ian Roberts and Peter Sandercock and Graham Teasdale and Jonathan Wasserberg and David Yates and Rory Collins and Stephen Haines and Stephen MacMahon and Charles Warlow and Phil Edwards and Arbara Farrell and Gabrielle Lomas and Nin Ritchie and Ian Roberts and Peter Sandercock and Aleema Shakur and Graham Teasdale and Jonathan Wasserberg and David Yates and Haleema Shakur and Ian Roberts and Phil Edwards and Maria Ramos and Lin Barnetson and Janice Fernandes and Donna Tooth and Cari Free and Leena Narayanan and Johan Collander and Julia Abernethy and Josephine Bardswell and Nin Ritchie and Reshma Mashru and Catherine Godward and Elizabeth Afolabi and Adrian Ritchie and Tessa Hosford and Shiela Pantrini and Sheila Massey and Amber Collingwood and Phil Edwards and Miguel Arango and Laura Balica and Rowland Cottingham and Hesham El-Sayed and Barbara Farrell and Janice Fernandes and Tamar Gogichaisvili and Nyoman Golden and Bennie Hartzenberg and Mazhar Husain and Ulloa, {Mario Izurieta} and Zouheir Jerbi and Hussein Khamis and Edward Komolafe and V{\'e}ronique Lalo{\"e} and Gabrielle Lomas and Silke Ludwig and Guy Mazairac and {De Los Angeles Mu{\~n}oz Sanch{\'e}z}, Maria and Luis Nasi and Fatos Olldashi and Patrick Plunkett and Ian Roberts and Peter Sandercock and Haleema Shakur and Caridad Soler and Reto Stocker and Petr Svoboda and Stefan Trenkler and Venkataramana, {N. K.} and Jonathan Wasserberg and David Yates and Surakrant Yutthakasemsunt",

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AU - Baigent, Colin

AU - Bracken, Michael

AU - Chadwick, David

AU - Curley, Kevin

AU - Duley, Lelia

AU - Farrell, Barbara

AU - Haegi, Marcel

AU - Lomas, Gabrielle

AU - Nickson, Graham

AU - Peto, Richard

AU - Pickard, John

AU - Roberts, Ian

AU - Sandercock, Peter

AU - Teasdale, Graham

AU - Wasserberg, Jonathan

AU - Yates, David

AU - Collins, Rory

AU - Haines, Stephen

AU - MacMahon, Stephen

AU - Warlow, Charles

AU - Edwards, Phil

AU - Farrell, Arbara

AU - Lomas, Gabrielle

AU - Ritchie, Nin

AU - Roberts, Ian

AU - Sandercock, Peter

AU - Shakur, Aleema

AU - Teasdale, Graham

AU - Wasserberg, Jonathan

AU - Yates, David

AU - Shakur, Haleema

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AU - Edwards, Phil

AU - Ramos, Maria

AU - Barnetson, Lin

AU - Fernandes, Janice

AU - Tooth, Donna

AU - Free, Cari

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AU - Collander, Johan

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AU - Bardswell, Josephine

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AU - Hosford, Tessa

AU - Pantrini, Shiela

AU - Massey, Sheila

AU - Collingwood, Amber

AU - Edwards, Phil

AU - Arango, Miguel

AU - Balica, Laura

AU - Cottingham, Rowland

AU - El-Sayed, Hesham

AU - Farrell, Barbara

AU - Fernandes, Janice

AU - Gogichaisvili, Tamar

AU - Golden, Nyoman

AU - Hartzenberg, Bennie

AU - Husain, Mazhar

AU - Ulloa, Mario Izurieta

AU - Jerbi, Zouheir

AU - Khamis, Hussein

AU - Komolafe, Edward

AU - Laloë, Véronique

AU - Lomas, Gabrielle

AU - Ludwig, Silke

AU - Mazairac, Guy

AU - De Los Angeles Muñoz Sanchéz, Maria

AU - Nasi, Luis

AU - Olldashi, Fatos

AU - Plunkett, Patrick

AU - Roberts, Ian

AU - Sandercock, Peter

AU - Shakur, Haleema

AU - Soler, Caridad

AU - Stocker, Reto

AU - Svoboda, Petr

AU - Trenkler, Stefan

AU - Venkataramana, N. K.

AU - Wasserberg, Jonathan

AU - Yates, David

AU - Yutthakasemsunt, Surakrant

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N2 - MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10 008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96 7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25 7%] vs 1075 [22 3%] deaths; relative risk 1 15, 95% CI 1 07-1 24; p=0 0001), as was the risk of death or severe disability (1828 [38 1%] vs 1728 [36 3%] dead or severely disabled; 1 05, 0 99-1 10; p=0 079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.

AB - MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10 008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96 7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25 7%] vs 1075 [22 3%] deaths; relative risk 1 15, 95% CI 1 07-1 24; p=0 0001), as was the risk of death or severe disability (1828 [38 1%] vs 1728 [36 3%] dead or severely disabled; 1 05, 0 99-1 10; p=0 079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.

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VL - 365

SP - 1957

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JO - The Lancet

JF - The Lancet

IS - 9475

ER -

Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury - outcomes at 6 months

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