Random trauma-list Journal Club

[Timothy J Coats (SURG) 7728]

Karim wrote:
> 
> Although these figures represent an improvement on the 1991 figures, and
> there are encouraging signs in factors such as maintenance of cerebral
> perfusion pressure, these figures show a significant disparity of care.
> 
> I'd be surprised (and interested) to learn of any neurosurgeons in the UK
> still using steroids for tbi.
> 

Steroids are being used in many centers in the UK as part of the 
CRASH trial. See http://astra.ich.ucl.ac.uk:80/crash/

This is a multinational trial. I would encourage anyone with an 
interest in this area to read Ian Roberts' systematic review  
(published in the BMJ and linked from the CRASH website) and to 
get involved in the trial.

Whether you 'believe' in steroids in tbi or not, without this sort of 
study we will be having the same argument in 10 years time. For 
those in the USA who have mentioned early discussions about a 
similar study - why not join in with the CRASH trial instead?

Tim.

Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.