Original Papers

Research in Experimental Medicine

, Volume 195, Issue 1, pp 217-229

First online:

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

  • Thomas GrummeAffiliated withDepartment of Neurosurgery, Zentralklinikum Augsburg
  • , Alexander BaethmannAffiliated withInstitute of Surgical Research, Klinikum Großhadern, University of Munich
  • , Dietrich KolodziejczykAffiliated withDepartment of Neurosurgery, Zentralklinikum Augsburg
  • , Jürgen KrimmerAffiliated withInstitute of Numerical Statistics
  • , Michael FischerAffiliated withInstitute of Numerical Statistics
  • , Barbara v. Eisenhart RotheAffiliated withBristol-Myers Squibb
  • , Rainer PelkaAffiliated withCenter of Biometrics, Bundeswehr-University
  • , Heinz BennefeldAffiliated withDepartment of Neurosurgery, University of Münster
  • , Erich PöllauerAffiliated withDivision of Neurosurgery, Municipal Hospital
    • , Herzig KostronAffiliated withDepartment of Neurosurgery, University of Innsbruck
    • , Fuad LehetaAffiliated withDepartment of Neurosurgery, Municipal Hospital Offenbach
    • , Stefan NecekAffiliated withDivision of Anesthesiology and Intensive Care Medicine
    • , Gertraud NeeserAffiliated withInstitute of Anesthesiology, Zentralklinikum Augsburg
    • , Wilfried SachsenheimerAffiliated withDepartment of Neurosurgery, University Heidelberg-Mannheim
    • , Josef SommerauerAffiliated withDivision of Neurosurgery, State Hospital for Nervous Diseases
    • , Frank VerhoevenAffiliated withDepartment of Neurosurgery, Klinikum Großhadern, University of Munich

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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 injury Glucocorticosteroids Triamcinolone acetonide Prospective clinical trial Glasgow outcom scale