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Background: Worldwide, millions of people are treated each year for significant
head injury. A substantial proportion die, and many more are disabled. If
short term corticosteroid infusion could be reliably shown to reduce these
risks by just a few percent then this might affect the treatment of a few
hundred thousand patients a year, protecting thousands from death or long
term disability.
Study design: CRASH is a large simple, placebo-controlled trial of the effects
of a 48-hour infusion of corticosteroids on death and on neurological disability,
among adults with head injury and some impairment of consciousness. Head
injured patients with impaired consciousness who are judged to be 16 years
or older are eligible if the responsible doctor is, for any reason, substantially
uncertain whether or not to use corticosteroids.
Organisation: The CRASH trial will determine reliably the effects on death
and disability of a short corticosteroid infusion following significant head
injury. To detect or refute improvements of only a few percent in outcome,
many thousands of acute head injury patients must be randomised between control
and steroid infusions. Such large numbers will be possible only if hundreds
of doctors and nurses can collaborate in the participating emergency departments.
Since they are busy, and working in emergency situations, the trial involves
them in almost no extra work: no special investigations or changes to usual
management are required, and data collection is absolutely minimal. The trial
is on-going and new collaborators are welcome. Further information about
the trial is available at www.crash.lshtm.ac.uk
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