Role of Corticosteroids in the Management of Acute Traumatic Brain Injury: Literature Review and Critical Appraisal of Evidence

Abstract

Background Traumatic brain injury is a prominent and leading cause of premature mortality and disability. Corticosteroids were widely used in the clinical management of traumatic brain injury but their benefit has been challenged in so many studies and their efficacy but their use in TBI still remains unclear. The aim of this review is to evaluate the effectiveness and efficacy of corticosteroids in reducing mortality or morbidity in people with acute traumatic brain injury. Methods A systematic literature searches as enabled a thorough and robust process of rigorous critical appraisal in order to make an informed, balanced and evidenced based judgement on the use of corticosteroids in the management of acute traumatic brain injury to quantify effectiveness of corticosteroids in reducing mortality and morbidity in reducing traumatic brain injury. Results Systematic literature search relevant to corticosteroid use in acute traumatic brain injury. The search strategy involving data base including Embase, MEDLINE, Cochrane Database of Systematic Review Seven studies have been critically appraised to determine the effectiveness and efficacy of corticosteroid use in acute traumatic brain injury. Conclusion It can be safely concluded that there is no significant benefit or efficacy of the use of corticosteroid in the management of acute traumatic brain injury. There is no reduction in mortality with the use of corticosteroid however progesterone use caused no discernible harm and showed possible sign of benefit but in a very small and single institution study. Overall the efficacy of amino-steroids in patients with moderate and severe head injury could not be demonstrated.