***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The conflicting evidence concerning the influence of high-dose steroids on intracranial pressure ( ICP ) and outcome following severe head injury has led to the institution of the prospect i ve double-blind controlled trial reported here . Severely head-injured patients admitted to intensive care during a 3-year period were r and omly allocated to a dexamethasone- or placebo-treated group . Adults in the steroid group received dexamethasone , 50 mg intravenously , as a bolus on admission to the neurosurgical unit , then 100 mg on Days 1 , 2 , and 3 , 50 mg on Day 4 , and 25 mg on Day 5 on continuous intravenous infusion . Children received proportionate intravenous dosages calculated on a weight basis . Severity of head injury was assessed from admission Glasgow Coma Scale ( GCS ) scores and the appearance of the admission computerized tomography scan . Intracranial pressure ( ICP ) was monitored in all patients from the surface subarachnoid space . Outcome at 6 months was assessed using the Glasgow Outcome Scale .  Steroid and placebo groups were similar in terms of admission GCS score , intracranial pathology , incidence of associated injuries , and time interval from injury to admission to intensive care . The ICP generally increased during the first 48 hours of intensive therapy ; there was no difference in this trend between the steroid and placebo groups . A poorer outcome was observed in patients with elevated ICP who received steroids . No increase in the incidence of pulmonary , gastrointestinal , or other extracranial complications was seen in the steroid group . The 6-month outcome did not differ between the steroid and placebo groups . No advantage of high-dose dexamethasone on ICP trends or clinical outcome in the treatment of severe head injury has emerged from this study In a prospect i ve r and omized double-blind multicenter trial , the efficacy and safety of a 51-hour ultra-high intravenous dexamethasone dosing regimen was investigated in patients with moderate and severe head injury . 300 patients between 15 and 55 years of age were r and omized to receive either placebo or dexamethasone : 500 mg intravenous infusion within 3 h after trauma initially , followed by 200 mg after 3 h , thereafter 8 times 200 mg at 6 hourly intervals , result ing in a total administered dose of 2,3 g in 51 hours . Primary end points for assessment of efficacy were : Modified Glasgow Coma Scale ( grading 3 - 16 ) on Day 5 , modified Glasgow Outcome Scale ( grading 1 - 6 ) 10 - 14 months after injury , and the time interval until consciousness improved above a level of modified GCS > or = 8 . Secondary endpoints were CT results and neurological and laboratory data . The two groups were well matched with respect to important prognostic variables , such as age , severity of trauma , and interval between trauma and application of the drug . 269 patients ( 89.7 % ) were available for final examination after 10 - 14 months . Results were surprisingly favourable in both groups : Lethality in the dexamethasone and placebo group was 14.3 and 15.4 % , respectively , and 61.7 and 57.4 % , respectively , achieved social and professional rehabilitation after 10 - 14 months ( outcome scale 6 ) . No statistical difference was seen between the dexamethasone and the placebo group in any of the primary end points of efficacy and safety ( incidence of upper gastrointestinal bleeding , infection , and thrombosis ) . ( ABSTRACT TRUNCATED AT 250 WORDS Summary Out of a total of 157 hospitalized head-injured children , twelve years of age and under , fifteen were considered to be severe , three of whom died within 72 hours of admission . Nine children with closed head injuries who were in coma for at least 24 hours ( did not open eyes , speak , or follow comm and s ) , with absent or impaired oculocephalic reflex , impaired pupil reactivity to light , and who were decerebrating for at least twelve hours , were studied . Five were given high dose dexamethasone therapy ( 1 mg/kg ) within six hours of injury , repeated at six hours , and then maintained at 1 mg/kg/day for eight days , and four either received none or were treated with a low dose regimen ( 0.25 mg/kg/day ) . In those receiving high dose therapy , intracranial pressure waves were noticeably less , peak intracranial pressure was lower , and intensive care and hospital stay were shorter . It was also noted that in the high dose therapy group spontaneous eye opening and speech returned sooner , and all were considered to have returned to their premorbid status by six months following injury . Of the no steroid or low dose group , one died , and of the remainder at six months one was aphasic and still decerebrating , another was aphasic and severely h and icapped , and the third returned to school seven months after injury 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 prospect i ve , double-blind , multicenter clinical trial , 396 patients with severe head injury were r and omized 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 st and ard 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 A prospect i ve r and omised study was performed on 25 children aged 1.4 to 15.8 years with severe head injury ( Glasgow Coma Scale⪕7 ) to determine the clinical effectiveness and the impact on endogenous cortisol production of high-dose steroid therapy .  Thirteen patients ( group 1 ) received dexamethasone 1 mg/kg/day during the first 3 days and 12 ( group 2 ) not . All patients were treated with a  st and ardized regimen  . Urinary free cortisol was measured by radioimmunoassay , and the clinical data were recorded at hourly intervals . Outcome was assessed 6 months later using the Glasgow Outcome Scale . We found a higher frequency of bacterial pneumonias in the dexamethasone-treated patients ( 7/13 versus 2/12 ) . Group 1 showed a suppression of endogenous cortisol production from day 1 to day 6 . In group 2 , menu free cortisol was up to 5-fold higher than under basal conditions . The results in group 2 showed taht the endogenous steroid production reacts adequately to the stress of severe head injury . It probably is sufficient to elicit maximum glucocorticoid effects . There was no other statistically significant difference in the clinical and laboratory data between the two groups . We conclude that dexamethasone in high doses suppresses endogenous cortisol production up to 6 days and may increase the risk of bacterial infection without affecting the outcome or the clinical and laboratory data In 1990 , the Second National Acute Spinal Cord Injury Study reported that high-dosage methylprednisolone improves neurologic recovery in spinal-injured humans . The study showed that patients who received the drug within 8 hr after injury improved , whereas those who received the drug later did not . The drug significantly increased recovery even in severely injured patients who were admitted with no motor or sensory function below the lesion , contradicting a long-held dogma that such patients would not recover . Some research ers , however , have question ed the stratification of the patient population , the use of summed neurologic change scores , and the absence of functional assessment s. The stratification by injury severity and treatment time was planned a priori and based on objective criteria . Detailed analyses revealed no differences between groups attributable to stratification or r and omization . While multivariate analyses of the summed neurologic scores were used , the conclusions were corroborated by other analytical approaches that did not rely on summed scores . For example , treatment with methylprednisolone more than doubled the probability that patients would convert from quadriplegia or paraplegia to quadriparesis or paraparesis , analgesia to hypalgesia , and anesthesia to hypesthesia . The treatment also significantly improved neurologic scores in lumbosacral segments , indicating that beneficial effects were not limited to segments close to the lesion site . The treatment did not significantly affect mortality or morbidity . The study strongly suggests that methylprednisolone has significant beneficial effects in human spinal cord injury , that these effects occur only when the drug is given within 8 hr , and that it helps even in patients with severe spinal cord injuries . These conclusions have important implication s for spinal cord injury care and research A prospect i ve double-blind study of the effects of dexamethasone administration on the outcome of patients with severe head injuries was performed . Patients were stratified for severity of neurological injury and were treated with placebo , low-dose dexamethasone ( 16 mg/day ) , or high-dose dexamethasone ( 96 mg/day ) for a period of 6 days . Outcome was evaluated at 6 months following injury . Of the 76 patients available for analysis , a good outcome was achieved in 37 % of placebo-treated patients , 44 % of low-dose-treated patients , and 29 % of high-dose-treated patients . These differences are not statistically significant . Similarly dexamethasone administration had no statistically significant effect on intracranial pressure patterns or serial neurological examinations during hospitalization . Gastrointestinal bleeding occurred in only one patient . Good outcome was associated with age under 10 years , lighter depth of coma on admission , and the preservation of brain-stem reflexes upon admission . A recalculation of data in previous clinical series purporting to show an improvement in outcome as a result of corticosteroid therapy shows no significant difference in outcome when steroid- and placebo-treated patients are compared . In our series , 90 % of all deaths were caused by recurrent intracranial hematomas , medical complications , or diffuse brain injuries with parenchymal hemorrhage and tissue disruption -- causes of death which can not be affected by corticosteroid therapy . The study suggests that dexamethasone in either high or low dosages has no significant effect on morbidity and mortality following severe head injury This is a prospect i ve r and omized study of the efficacy of steroid therapy in patients with severe head injury . One hundred patients were r and omized into two equal groups : the steroid group received 5 mg/kg/day of methylprednisolone , and the nonsteroid group received no drug . The groups were similar in their clinical features . All patients received a st and ardized therapeutic regimen . The patients were also classified as early responders or nonresponders to the overall treatment protocol without regard to steroid administration , on the basis of change in Glasgow Coma Scale score during the first 3 days of admission . There was no statistically significant difference in the outcome of the steroid and nonsteroid group at 6 months . Of the responders who were on steroids , 74 % had good outcomes or were disabled , compared with 56 % of the responders who did not receive steroids . In the nonresponder group , the patients on steroids were actually associated with a worse outcome than those who did not receive steroids : 75 % of the nonresponders who received steroids were dead or vegetative , compared to 56 % of those who were not receiving steroids . The data suggest that : 1 ) the effect of steroids may be different for different patient groups ; 2 ) in order to identify these patients , a sensitive coma scale is needed ; and 3 ) a rational approach to steroid therapy in head-injured patients may be to start all patients on steroids , but to discontinue their use in patients identified as not benefiting from steroid therapy MRC CRASH is a r and omised controlled trial ( IS RCT N74459797 ) of the effect of corticosteroids on death and disability  after head injury . We r and omly allocated 10,008 adults with head injury and a Glasgow Coma Scale score of 14 or less , within 8 h of injury , to a 4 
    Output:
    
The increase in mortality with steroids in this trial suggest that steroids should no longer be routinely used in people with traumatic head injury