Research in Experimental Medicine

, Volume 195, Issue 1, pp 217–229

Treatment of patients with severe head injury by triamcinolone: a prospective, controlled multicenter clinical trial of 396 cases

Authors

  • Thomas Grumme
    • Department of NeurosurgeryZentralklinikum Augsburg
  • Alexander Baethmann
    • Institute of Surgical Research, Klinikum GroßhadernUniversity of Munich
  • Dietrich Kolodziejczyk
    • Department of NeurosurgeryZentralklinikum Augsburg
  • Jürgen Krimmer
    • Institute of Numerical Statistics
  • Michael Fischer
    • Institute of Numerical Statistics
  • Barbara v. Eisenhart Rothe
    • Bristol-Myers Squibb
  • Rainer Pelka
    • Center of BiometricsBundeswehr-University
  • Heinz Bennefeld
    • Department of NeurosurgeryUniversity of Münster
  • Erich Pöllauer
    • Division of NeurosurgeryMunicipal Hospital
  • Herzig Kostron
    • Department of NeurosurgeryUniversity of Innsbruck
  • Fuad Leheta
    • Department of NeurosurgeryMunicipal Hospital Offenbach
  • Stefan Necek
    • Division of Anesthesiology and Intensive Care Medicine
  • Gertraud Neeser
    • Institute of AnesthesiologyZentralklinikum Augsburg
  • Wilfried Sachsenheimer
    • Department of NeurosurgeryUniversity Heidelberg-Mannheim
  • Josef Sommerauer
    • Division of NeurosurgeryState Hospital for Nervous Diseases
  • Frank Verhoeven
    • Department of Neurosurgery, Klinikum GroßhadernUniversity of Munich
Original Papers

DOI: 10.1007/BF02576791

Cite this article as:
Grumme, T., Baethmann, A., Kolodziejczyk, D. et al. Res. Exp. Med. (1995) 195: 217. doi:10.1007/BF02576791

Abstract

The present studies were conducted to test whether the outcome of severe head injury is improved by early administration of the synthetic corticosteroid triamcinolone. In a prospective, double-blind, multicenter clinical trial, 396 patients with severe head injury were randomized to a steroid group (n=187) receiving 200 mg triamcinolone acetonide (Volon A soluble) i.v. within 4 h after trauma, followed by 3×40 mg/day i.v. for 4 days, and 3×20 mg/day i.v. for a further 4 days, and a placebo group (n=209) receiving injections which did not contain any active drug. The placebo group was subjected to the same standard treatment procedures. Clinical features were not different between the groups upon admission to hospital. Subdural hematoma, epidural hematoma, and focal supratentorial contusion were among the most frequent diagnoses. The result of treatment with triamcinolone was assessed at discharge from the hospital and at 1 year after trauma. using the Glasgow Outcome Scale. Differences in favor of steroid treatment could be detected with regard to the patients' condition at discharge (P=0.0634). More patients with steroids had a good recovery (49.2% vs 40.7%), and fewer died (16.0% vs 21.5%). Differences in outcome were even more pronounced (P<0.0145) in patients with a focal lesion and a Glasgow Coma Score on admission of <8 (n=93). In this group, 34.8% of the patients made a good recovery, as against 21.3% of the placebo group; mortality was also lower in the verum group (19.6% vs 38.3%). The results indicate that a major subgroup of patients with severe head injury benefits from early administration of triamcinolone. Efficacy of the treatment can be expected, in particular, in patients with a focal cerebral lesion and a Glasgow Coma Score of <8 on admission. Administration of steroids beginning at the scene of an accident would therefore be beneficial in these cases.

Key words

Severe head injuryGlucocorticosteroidsTriamcinolone acetonideProspective clinical trialGlasgow outcom scale

Copyright information

© Springer-Verlag 1995