Skip to main content
SpringerLink
Log in

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

  • Original Papers
  • Published:
Research in Experimental Medicine

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Galicich JH, French LA (1961) The use of dexamethasone in the treatment of cerebral edema resulting from brain tumors and brain surgery. Am Pract Dig Treat 12: 169–174

    PubMed  CAS  Google Scholar 

  2. Bauer RB, Tellez H (1973) Dexamethasone as treatment in cerebrovascular disease. 2. A controlled study in acute cerebral infarction. Stroke 4: 547–555

    PubMed  CAS  Google Scholar 

  3. Norris JW, Hachinski VC (1986) High dose steroid treatment in cerebral infarction. Br Med J 292: 21–23

    CAS  Google Scholar 

  4. Tellez H, Bauer RB (1973) Dexamethasone as treatment in cerebrovascular disease. 1. A controlled study in intracerebral hemorrhage. Stroke 4: 541–546

    PubMed  CAS  Google Scholar 

  5. Poungvarin N, Bhoopat W, Viriyavejakul A et al. (1987) Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. N Engl J Med 316: 1229–1233

    Article  PubMed  CAS  Google Scholar 

  6. Chyatte D, Fode NC, Nichols DA, Sundt TM Jr (1987) Preliminary report: effects of high dose methylprednisolone on delayed ischemia in patients at high risk for vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 21: 157–160

    Article  PubMed  CAS  Google Scholar 

  7. Sparacio RR, Lin TH, Cook AW (1965) Methylprednisolone sodium succinate in acute craniocerebral trauma. Surg Gynecol Obstet 121: 513–516

    PubMed  CAS  Google Scholar 

  8. Gobiet W, Bock WJ, Liesegang J, Grote W (1976) Treatment of acute cerebral edema with high dose of dexamethasone. In: Beks JWF, Bosch DA, Brock M (eds) Intracranial pressure III. Springer, Berlin Heidelberg New York, pp 231–235

    Google Scholar 

  9. Faupel G, Reulen HJ, Müller D, Schürmann K (1976) Double-blind study on the effects of steroids on severe closed head injury. In: Pappius HM, Feindel W (eds) Dynamics of brain edema. Springer, Berlin Heidelberg New York, pp 337–343

    Google Scholar 

  10. Cooper PR, Moody S, Clark WK, et al. (1979) Dexamethasone and severe head injury. A prospective double-blind study. J Neurosurg 51: 307–316

    PubMed  CAS  Google Scholar 

  11. Gudeman SK, Miller JD, Becker DP (1979) Failure of high-dose steroid therapy to influence intracranial pressure in patients with severe head injury. J Neurosurg 51: 301–306

    PubMed  CAS  Google Scholar 

  12. Saul TG, Ducker TB, Salcman M, Carro E (1981) Steroids in severe head injury. A prospective randomized clinical trial. J Neurosug 54: 596–600

    CAS  Google Scholar 

  13. Braakman R, Schouten HJA, Blaauw-van Dishoek M, Minderhoud JM (1983) Megadose steroids in severe head injury. Results of a prospective double-blind clinical trial. J Neurosurg 58: 326–330

    PubMed  CAS  Google Scholar 

  14. Giannotta SL, Weiss MH, Apuzzo MLJ, Martin E (1984) High dose glucocorticoids in the management of severe head injury. Neurosurgery 15: 497–501

    Article  PubMed  CAS  Google Scholar 

  15. Dearden NM, Gibson JS, McDowall DG, Gibson RM, Cameron MM (1986) Effect of high-dose dexamethasone on outcome from severe head injury. J Neurosurg 64: 81–88

    PubMed  CAS  Google Scholar 

  16. Becker DP (1979) Viewpoint: severe closed head injury. Neurosurgery 4: 277–278

    Article  PubMed  Google Scholar 

  17. Tindall GT (1979) Viewpoint: severe closed head injury. Neurosurgery 4: 277–278

    Article  PubMed  Google Scholar 

  18. Hall ED (1982) Glucocorticoid effects on central nervous excitability and synaptic transmission. Int Rev Neurobiol 23: 165–195

    PubMed  CAS  Google Scholar 

  19. Braughler JM, Hall ED (1982) Correlation of methylprednisolone in cat spinal cord with its effects on (Na+, K+)-ATPase, lipid peroxidation, and alpha motor neuron function. J Neurosurg 56: 838–844

    PubMed  CAS  Google Scholar 

  20. Young W, Flamm ES (1982) Effect of high-dose corticosteroid therapy on blood flow, evoked potentials, and extracellular calcium in experimental spinal injury. J Neurosurg 57: 667–673

    PubMed  CAS  Google Scholar 

  21. Umlauf B, Trappe A, Haack D, Rampel C, Krämer W (1983) The influence of triamcinolone acetonide on raised ICP. In: Ishii S, Nagai H, Brock M (eds) Intracranial pressure V. Springer, Berlin Heidelberg New York, pp 772–776

    Google Scholar 

  22. Braughler JM, Hall ED (1985) Current application of “high-dose” steroid therapy for CNS injury. A pharmacological perspective. J Neurosurg 62: 806–810

    PubMed  CAS  Google Scholar 

  23. Meinig G, Deisenroth K (1990) Dose- and time-dependent effects of dexamethasone on rat brain following cold-injury oedema. Acta Neurochir Suppl (Wien) 51: 100–103

    CAS  Google Scholar 

  24. Meinig G, Deisenroth K, Behl M, Khalifa A (1986) Dosis-Wirkungs-Beziehung von Dexamethason beim Kälteläsion-induzierten Hirnödem der Ratte. In: Walter W, Krenkel W (eds) Jahrbuch der Neurochirurgie. Regensburg & Biermann, Münster, pp 177–191

    Google Scholar 

  25. Gaab MR, Dietz H (1989) Ultrahohe Dexamethason-Kurzzeittherapie bei Schädel-Hirn-Trauma. Rationale und Design einer Multicenter-Studie. Neurochirurgia 32: 93–100

    PubMed  CAS  Google Scholar 

  26. Kobrine AI, Kempe LG (1975) Studies in head injury: part II. Effect of dexamethasone on traumatic brain swelling. Surg Neurol 1: 38–42

    Google Scholar 

  27. Yamaguchi M, Shirakata S, Taomoto K, Matsumoto S (1975) Steroid treatment of brain edema. Surg Neurol 4: 5–8

    PubMed  CAS  Google Scholar 

  28. Hall ED, Braughler JM (1982) Glucocorticoid mechanisms in acute spinal cord injury. A review and therapeutic rationale. Surg Neurol 18: 320–327

    Article  PubMed  CAS  Google Scholar 

  29. Faden AI, Jacobs TP, Patrick DH, Smith MT (1984) Megadose corticosteroid therapy following experimental traumatic spinal injury. J Neurosurg 60: 712–717

    PubMed  CAS  Google Scholar 

  30. Herrmann F, Gaab MR, Pflughaupt KW, Gruss P (1981) Medikamentöse Therapie beim experimentellen Hirnödem. Neurochirurgia 24: 39–46

    PubMed  CAS  Google Scholar 

  31. Palleske H, Herrmann HD, Kremer G (1970) Verlaufsuntersuchungen über Veränderungen des Elektrolyt- und Wassergehaltes im experimentellen Hirnödem und deren therapeutische Beeinflußbarkeit durch Dexamethason. Zentralbl Neurochir 30: 31–38

    Google Scholar 

  32. Hall ED (1985) High-dose glucocorticoid treatment improves neurological recovery in head-injured mice. J Neurosurg 62: 882–887

    PubMed  CAS  Google Scholar 

  33. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84

    Article  PubMed  CAS  Google Scholar 

  34. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484

    Article  PubMed  CAS  Google Scholar 

  35. Hall ED, Braughler JM (1981) Acute effects of intravenous glucocorticoid pretreatment on the in vitro peroxidation of cat spinal cord tissue. Exp Neurol 73: 321–324

    Article  PubMed  CAS  Google Scholar 

  36. Hall ED (1982) Acute effects of intravenous glucocorticoid on cat spinal motor neuron electrical properties. Brain Res 240: 186–190

    Article  PubMed  CAS  Google Scholar 

  37. Gennarelli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA, Marshall LF, Miller JD, Pitts LH (1982) Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 56: 26–32

    PubMed  CAS  Google Scholar 

  38. Braughler JM, Hall ED (1984) Effects of multi-dose methylprednisolone sodium succinate administration on injured cat spinal cord neurofilament degradation and energy metabolism. J Neurosurg 61: 290–295

    PubMed  CAS  Google Scholar 

  39. Means ED, Anderson DK, Waters TR, Kalaf L (1981) Effect of methylprednisolone in compression trauma to the feline spinal cord. J Neurourg 55: 200–208

    CAS  Google Scholar 

  40. Bracken MB, Shepard MJ, Collins WF, et al. (1990) A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the second national acute spinal cord injury study. N Engl J Med 322: 1405–1411

    Article  PubMed  CAS  Google Scholar 

  41. Gaab M (1986) Kortikosteroid-Therapie beim Schädel-Hirn-Trauma. In: Walter W, Krenkel W (eds) Jahrbuch der Neurochirurgie. Regensberg & Biermann, Münster, pp 13–30

    Google Scholar 

  42. Gutterman P, Shenkin HA (1970) Prognostic features in recovery from traumatic decerebration. J Neurosurg 32: 330–335

    PubMed  CAS  Google Scholar 

  43. Alexander E, Jr (1972) Medical management of closed head injuries. Clin Neurosurg 19: 240–250

    PubMed  Google Scholar 

  44. Bolt HM (1980) Zur Frage der Äquivalenzdosen von Kortikosteroiden. Therapiewoche 30: 6257–6259

    Google Scholar 

  45. Braughler JM, Hall ED, Means ED, Waters TR, Anderson DK (1987) Evaluation of an intensive methylprednisolone sodium succinate dosing regimen in experimental spinal cord injury. J Neurosurg 67: 102–105

    Article  PubMed  CAS  Google Scholar 

  46. Pitts LH, Kaktis JV (1980) Effect of megadose steroids on ICP in traumatic coma. In: Shulman K, Marmarou A, Miller JD, et al. (eds) Intracranial pressure IV. Springer, Berlin Heidelberg New York, pp 638–642

    Google Scholar 

  47. Marshall LF, King J, Langfitt TW (1977) The complications of high-dose corticosteroid therapy in neurosurgical patients: a prospective study. Ann Neurol 1: 201–203

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Zentralklinikum Augsburg, Stenglinstrasse, D-86156, Augsburg, Germany

    Thomas Grumme & Dietrich Kolodziejczyk

  2. Institute of Surgical Research, Klinikum Großhadern, University of Munich, Germany

    Alexander Baethmann

  3. Institute of Numerical Statistics, Cologne, Germany

    Jürgen Krimmer & Michael Fischer

  4. Bristol-Myers Squibb, Munich, Germany

    Barbara v. Eisenhart Rothe

  5. Center of Biometrics, Bundeswehr-University, Munich, Germany

    Rainer Pelka

  6. Department of Neurosurgery, University of Münster, Germany

    Heinz Bennefeld

  7. Division of Neurosurgery, Municipal Hospital, Klagenfurt, Austria

    Erich Pöllauer

  8. Department of Neurosurgery, University of Innsbruck, Austria

    Herzig Kostron

  9. Department of Neurosurgery, Municipal Hospital Offenbach, Germany

    Fuad Leheta

  10. Division of Anesthesiology and Intensive Care Medicine, City Hospital, Linz, Austrial

    Stefan Necek

  11. Institute of Anesthesiology, Zentralklinikum Augsburg, Germany

    Gertraud Neeser

  12. Department of Neurosurgery, University Heidelberg-Mannheim, Germany

    Wilfried Sachsenheimer

  13. Division of Neurosurgery, State Hospital for Nervous Diseases, Salzburg, Austria

    Josef Sommerauer

  14. Department of Neurosurgery, Klinikum Großhadern, University of Munich, Germany

    Frank Verhoeven

Authors
  1. Thomas Grumme
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander Baethmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dietrich Kolodziejczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jürgen Krimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barbara v. Eisenhart Rothe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rainer Pelka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Heinz Bennefeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Erich Pöllauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Herzig Kostron
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Fuad Leheta
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Stefan Necek
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Gertraud Neeser
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Wilfried Sachsenheimer
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Josef Sommerauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Frank Verhoeven
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grumme, T., Baethmann, A., Kolodziejczyk, D. et al. Treatment of patients with severe head injury by triamcinolone: a prospective, controlled multicenter clinical trial of 396 cases. Res. Exp. Med. 195, 217–229 (1995). https://doi.org/10.1007/BF02576791

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02576791

Key words

Search

Navigation