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

  • Thomas Grumme
  • Alexander Baethmann
  • Dietrich Kolodziejczyk
  • Jürgen Krimmer
  • Michael Fischer
  • Barbara v. Eisenhart Rothe
  • Rainer Pelka
  • Heinz Bennefeld
  • Erich Pöllauer
  • Herzig Kostron
  • Fuad Leheta
  • Stefan Necek
  • Gertraud Neeser
  • Wilfried Sachsenheimer
  • Josef Sommerauer
  • Frank Verhoeven
Original Papers

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 

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Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Thomas Grumme
    • 1
  • Alexander Baethmann
    • 2
  • Dietrich Kolodziejczyk
    • 1
  • Jürgen Krimmer
    • 3
  • Michael Fischer
    • 3
  • Barbara v. Eisenhart Rothe
    • 4
  • Rainer Pelka
    • 5
  • Heinz Bennefeld
    • 6
  • Erich Pöllauer
    • 7
  • Herzig Kostron
    • 8
  • Fuad Leheta
    • 9
  • Stefan Necek
    • 10
  • Gertraud Neeser
    • 11
  • Wilfried Sachsenheimer
    • 12
  • Josef Sommerauer
    • 13
  • Frank Verhoeven
    • 14
  1. 1.Department of NeurosurgeryZentralklinikum AugsburgAugsburgGermany
  2. 2.Institute of Surgical Research, Klinikum GroßhadernUniversity of MunichGermany
  3. 3.Institute of Numerical StatisticsCologneGermany
  4. 4.Bristol-Myers SquibbMunichGermany
  5. 5.Center of BiometricsBundeswehr-UniversityMunichGermany
  6. 6.Department of NeurosurgeryUniversity of MünsterGermany
  7. 7.Division of NeurosurgeryMunicipal HospitalKlagenfurtAustria
  8. 8.Department of NeurosurgeryUniversity of InnsbruckAustria
  9. 9.Department of NeurosurgeryMunicipal Hospital OffenbachGermany
  10. 10.Division of Anesthesiology and Intensive Care MedicineCity Hospital, LinzAustrial
  11. 11.Institute of AnesthesiologyZentralklinikum AugsburgGermany
  12. 12.Department of NeurosurgeryUniversity Heidelberg-MannheimGermany
  13. 13.Division of NeurosurgeryState Hospital for Nervous DiseasesSalzburgAustria
  14. 14.Department of Neurosurgery, Klinikum GroßhadernUniversity of MunichGermany

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