Doctors have treated head injuries with drugs known as corticosteroids for decades, but after studies failed to find much of a benefit, use has declined. Now new research from an international drug trial says that, far from being helpful, corticosteroids can actually be deadly.

What the researchers wanted to know: Do corticosteroids help patients with head injuries?

What they did: The researchers ran a 49-country trial of about 10,000 people with serious head injuries. They used people whose injuries were fresh—in the past eight hours—and whose doctors weren't sure if they needed corticosteroids or not. Each person was randomly assigned to get 48 hours of an IV containing either a placebo or methylprednisolone, a corticosteroid.

What they found: Patients who got the drug were 18 percent more likely to die within two weeks than patients who got the placebo. That's bad news—earlier studies suggested corticosteroids just didn't do much good, not that they would kill you. If you consider the number of people who've been given corticosteroids over the years, as two other researchers do in an editorial in the same issue of The Lancet, the drugs have probably killed thousands.

What the study means to you: Corticosteroids are no longer routinely given for head injuries, but the authors say they are often given for spinal-cord injuries. This study should add to the debate over that practice.

Caveats: The researchers didn't know why people died; just that they died within two weeks of being injured. They say they didn't try to collect cause of death because it's often hard to tell what actually kills a person with serious traumatic injuries.

Find out more: The homepage of the Corticosteroid Randomisation After Significant Head Injury (CRASH) trial

Read the article: CRASH trial collaborators. "Effect of Intravenous Corticosteroids on Death Within 14 Days in 10,008 Adults With Clinically Significant Head Injury (MRC CRASH trial): Randomised Placebo-Controlled Trial." The Lancet. Oct. 9, 2004, Vol. 364, pp. 1321-1328.

Sauerland, S. and M. Maegele. "A CRASH Landing in Severe Head Injury." The Lancet. October 9, 2004, Vol. 364, pp. 1291-1292.

Abstract online: www.ncbi.nlm.nih.gov