Corticosteroids in acute traumatic brain injury

Editor—The findings of the systematic review of randomised controlled trials of corticosteroids in acute traumatic brain injury1 are in keeping with the conclusions reached by the Committee for Guidelines for the Management of Severe Head Injury, based in the United States. They indicate that the available evidence does not show a benefit of corticosteroids in acute severe traumatic brain injury.2 The guidelines committee therefore recommended that corticosteroids should not be given routinely to patients with severe head injury. We are puzzled why the authors state that considerable uncertainty remains over the effect of corticosteroids and recommend that a trial requiring 20 000 participants is justified. The meta-analysis showed that the odds ratio for death was 0.91, corresponding to a pooled absolute risk reduction for death in head injured patients treated with steroids of 1.8%, which was far from being significant. Moreover, the subgroup analysis, which analysed trials with only the highest quality of concealment of allocation (blinding), showed that …