Key result
Pre-injury statin use and post-injury statin treatment may have beneficial effects on clinical outcomes in trauma, brain injury, and burns patients, though current evidence is at high risk of bias.
Why the study?
Does pre-injury statin use or post-injury statin treatment improve mortality, or functional outcomes, or reduce complications in patients who have suffered trauma in general, traumatic brain injury, burns, or fractures?
Systematic Review
Does pre-injury statin use or post-injury statin treatment improve mortality, or functional outcomes, or reduce complications in patients who have suffered trauma in general, traumatic brain injury, burns, or fractures?
Current evidence for the use of statins in trauma patients is limited by high risk of bias and confounding, serving only as hypothesis-generating for future well-designed RCTs.
Should not yet change trauma practice; leaves open potential benefit pending low-bias RCTs.
Statins, in addition to their lipid-lowering properties, have anti-inflammatory actions. The aim of this review is to evaluate the effect of pre-injury statin use, and statin treatment following injury. MEDLINE, EMBASE, and CENTRAL databases were searched to January 2012 for randomised and observational studies of statins in trauma patients in general, and in patients who have suffered traumatic brain injury, burns, and fractures. Of 985 identified citations, 7 (4 observational studies and 3 randomised controlled trials (RCTs)) met the inclusion criteria. Two studies (both observational) were concerned with trauma patients in general, two with patients who had suffered traumatic brain injury (one observational, one RCT), two with burns patients (one observational, one RCT), and one with fracture healing (RCT). Two of the RCTs relied on surrogate outcome measures. The observational studies were deemed to be at high risk of confounding, and the RCTs at high risk of bias. Three of the observational studies suggested improvements in a number of clinical outcomes in patients taking statins prior to injury (mortality, infection, and septic shock in burns patients; mortality in trauma patients in general; mortality in brain injured patients) whereas one, also of trauma patients in general, showed no difference in mortality or infection, and an increased risk of multi-organ failure. Two of three RCTs on statin treatment in burns patients and brain injured patients showed improvements in E-selectin levels and cognitive function. The third, of patients with radial fractures, showed no acceleration in fracture union. In conclusion, there is some evidence that pre-injury statin use and post-injury statin treatment may have a beneficial effect in patients who have suffered general trauma, traumatic brain injury, and burns. However, these studies are at high risk of confounding and bias, and should be regarded as 'hypothesisgenerating'. A well-designed RCT is required to determine the therapeutic efficacy in improving outcomes in this patient population.
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Jansen et al. (2013) conducted a systematic review in Trauma (general, traumatic brain injury, burns, fractures). Statins (pre-injury use or post-injury treatment) vs. No statin use or placebo was evaluated on Mortality, functional outcomes, and complications. Pre-injury statin use and post-injury statin treatment may have beneficial effects on clinical outcomes in trauma, brain injury, and burns patients, though current evidence is at high risk of bias.
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