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A trial of the effect of nimodipine on outcome after head injury

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Summary

We performed a randomised prospective double blind trial to study the effect of the calcium antagonist nimodipine on the outcome of head injured patients. The subjects were not obeying commands at the time of entry to the study, within 24 hours of injury. One hundred and seventy-five patients received nimodipine IV, 2 mg per hour for up to 7 days and 176 received placebo. The two groups were well matched for important prognostic features. Six months after injury 93 (53%) of the nimodipine group and 86 (49%) of the control group had a favourable outcome (moderate/good recovery). The relative increase in favourable outcomes (8%) was not significant but is compatible (95% C.I.) with an increase in favourable outcomes in treated patients by 33% or a decrease by 12%. Nimodipine was well tolerated and there were few adverse reactions; means of systolic and diastolic blood pressures and the intracranial pressure did not differ between the groups. It is unlikely that nimodipine has a marked effect on outcome (ie an increase in favourable outcome of >15%) after head injury of this severity but the study does not exclude a modest but clinically useful benefit.

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Authors and Affiliations

  1. Department of Neurosurgery Royal Victoria Hospital, Belfast

    I. Bailey & J. Gray

  2. Department of Neurosurgery, Atkinson Morley's Hospital, London

    A. Bell & H. Marsh

  3. Department of Regional Neurosurgical Unit, Brook General Hospital, London

    R. Gullan & G. Quaghebeur

  4. University of Helsinki, Finland

    O. Heiskanan, J. Ohman & G. Teasdale

  5. Department of Neurosurgery, Addenbrooke's Hospital, Cambridge

    P. V. Marks & A. Waters

  6. Department of Neurosurgery, Regional Neurological Centre, Newcastle Upon Tyne

    D. A. Mendelow & J. Sinar

  7. Department of Surgery, University of Glasgow, UK

    G. Murray

  8. Department of Clinical Trial Data Centre, University of Nottingham, UK

    A. Skene

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  1. I. Bailey
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  2. A. Bell
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  3. J. Gray
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  4. R. Gullan
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  6. P. V. Marks
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  7. H. Marsh
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  8. D. A. Mendelow
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  9. G. Murray
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  10. J. Ohman
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  11. G. Quaghebeur
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  14. G. Teasdale
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  15. A. Waters
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Bailey, I., Bell, A., Gray, J. et al. A trial of the effect of nimodipine on outcome after head injury. Acta neurochir 110, 97–105 (1991). https://doi.org/10.1007/BF01400674

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