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Annals of African Medicine
Annals of African Medicine Society
ISSN: 1596-3519
Vol. 4, Num. 2, 2005, pp. 92-93
Untitled Document

Annals of African Medicine, Vol. 4, No. 2, June, 2005, pp. 92-93

THE MRC CRASH STUDY: ANY LESSONS FOR US?

E. O. Komolafe, 1M. A. Komolafe and 2B. B. Shehu

Departments of Surgery and 1Medicine Obafemi Awolowo University Teaching Hospital, Ile Ife, Osun State and 2Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria E-mail: adeyoyin2001@yahoo.com, eokomolafe@hotmail.com

Code Number: am05024

Dear Editor

It is now known that corticosteroid use in head trauma is not beneficial and may actually contribute to increase morbidity and mortality in the head injured patients.  This is  due to the efforts of the just concluded MRC CRASH (Corticosteroid Randomisation After Significant Head Injury) study.1 Apart from putting to rest the controversy surrounding the use of steroids in the management of head injury, the study further gave insights into the pathophysiology of intracranial hypertension.2

There are some lessons to be learnt from the CRASH study which we believe will assist in future research works, particularly in Africa.  These include:

  1. A multicentre international collaborative work especially with a large sample is possible, even in emergency settings.  This is aided by advancement and spread in communication facilities particularly the internet and telephone services which made communication easier and quicker among the collaborators, a well designed grail method3, appropriate and adequate trial coordination, as well as adequate funding.  Governments, institutions, foundations, societies and willing individuals should be encouraged to provide the necessary funds needed for such work.
  2. Common disease condition of global impact that affect all irrespective of race, colour, tribe, religion, social status, age, sex, etc. are better studied and understood by combined international efforts.  It will be good if this type of study can be extended to other medical conditions in the nearest future, especially those peculiar to Africa.  Studies tailored for the paediatric patient should also be considered rather than transposing the results from adult studies to the children.
  3. Success of research works involve multidisciplinary contributions from expert specialists, even those that might not be primarily involved in the management of the condition being studied such as epidemiologists and statistician.
  4. We should always question a known, common and usual treatment modality even if such is widely accepted and practiced because our foundation for such practice may be false and such interventions may be harmful.  Therefore there is the need for constant reviews (audit) of our practice.
  5. Adequate, constant and regular data monitoring during the study is essential so that the trend of data could be followed up closely and the study can be stopped early if necessary as in CRASH 1 study where it was found that the intervention is harmful.
  6. What we think is important in a disease condition may not be right as in the first CRASH study.  Many people thought steroid use is the main stay of treatment of the head injured and sometimes may neglect other basic supportive care that has stood the test of time.
  7. Institution of a collaborative group that understand themselves, have a focus, united and experienced will go a long way in the success of any study.

Bearing these in mind will assist us in other studies.  Epidemiology, natural history, and peculiarities of management and outcome of disease conditions will be better understood.  Previous experiences will also help to minimize cost, the stress accompanying the study and the study may be completed in record time.  In the recently conducted CRASH study only four countries in Africa participated.  It is time also that Africa take up similar challenges and be more involved in  researches that will impact on health care delivery in the continent.

References 

  1. Roberts I, Yates D, Sandercock P et al.  Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomized placebo-controlled trial.  Lancet  2004; 364(9442): 1321-1328
  2. Sauerland S, Maegele A.  A CRASH landing in severe head injury.  Lancet 2004; 364 (9442): 1291-1292
  3. Roberts I.  Design of CRASH trial.  Trial is best way to elucidate effectiveness of corticosteroids in acute severe head injury.  BMJ 1999; 319 (7216): 1069

Copyright 2005 - Annals of African Medicine

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