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Primary outcome measures were death from any cause within 2 weeks of injury and death or disability at 6 months.0(Z3Z,Z, 6Statistical analysisEstimated risk of death allocated to placebo  15%. 2% survival difference would be clinically important so the trial size had to be large enough to detect a difference of this size.A trial of 20,000 patients would have a good chance of showing a 2% survival difference at convincing levels of significance ie >90% power to achieve p<0.01 Precision-95%CI for overall risk and 99%CI for subgroup results Homogenicity in treatment effects assessed within subgroups by X2 test at 5% significance level.Z,2] T7Results239 hospitals from 49 countries. 10,008 patients randomised to steroid or placebo infusion 62 <16 years, 21 enrolled > 8h after injury, 3 stopped at request of a relative.1 p8Baseline characteristics9Baseline characteristics-cont:Baseline characteristics-cont; Baseline characteristics-cont< Baseline characteristics-cont= Baseline characteristics-cont> Baseline characteristics-contAdherence to treatment-9,848(98%) 9,748(99%)received full loading dose. Mortality data obtained for 9,964 patients,4,985-CS M-1.052(21%) in 2wks, 4,979-P M-893(18%) RR of death from all causes in 2wks in CS group with placebo 1.18 RR of death at 2wks didn t differ by injury severity (p=0.22) or time since injury(p=0.05)FZFA<Effects of CS allocation on death in 2wks,by injury severity==DPEffects of CS allocation on death from all causes in 2 weeks by CT scan results.QQ? Comment on resultsRelative Risk of death at 2wks wasn t different in any of the 8 Ct diagnosis subgroups examined `B Conclusion  ` MMM̙f` f3 ޚ` ` ff,,B3f33` P3fPP3` ff333tfff` @EoOV>?" dd@,?nF3d@ `A  @`K``A n?" dd@   @@``@n?" dd@  @@``PR    @ ` `p>> NF 0 (  N ~d  "~d  c rAND:\FRONTPAGE THEMES\ARTSY\ARTHSEPA.PNG"5~d  S ZA<P:\!Themes\Artsy\Arthsepa.gif" D    `X55  @` ( <Ls?F  Q 1217(24%)   @` ( <s?F  Q 1151(23%)   @` ( <Us?  N25-34  @`fB  ( 6o ?`B  ( 01 ?  fB  ( 6o ?  fB  ( 6o ? `B ( 01 ? `B ( 01 ?FF fB ( 6o ? `B ( 01 ?2 2 `B $( 01 ?RB +( s *D  H ( 0޽h ? MMM̙f     x<W (  < f  r< #"i p< <?F0  O 1981(39%)   @` n< <?0F  O 1985(40%)   @` l< <0?0  Q Severe(3-8)   @` c< <t?F  Z1483(30%) 1537(31%) @` b< <? F Z1557(31%) 1465(29%) @` a< <?  aModerate(9-12) Mild(13-14) @` `< <?F0 GP @` _< <?F0 GC @` ^< <H?0 IGCS @`fB d< 6o ?`B e< 01 ?  fB f< 6o ?fB g< 6o ?`B h< 01 ?`B i< 01 ?FFfB j< 6o ?`B m< 01 ?00 s< # l   ȜȜ?    RB t< s *D  H < 0޽h ? MMM̙fl  @(  @ j T @ #""``T @ <KW?F  O 1347(27%)   @` @ <YW? F O 1350(27%)   @` @ <`W?  H<1 @`  @ <xhW?F T O 2087(42%)   @`  @ <|iW? FT O 2125(42%)   @`  @ <HqW? T J>3<8 @`  @ <1<3 @` @ <`W?F  P  @` @ <xW?F  P  @` @ <̤W?  TTime of injury @`fB  @ 6o ?`B @ 01 ?`B @ 01 ?  fB @ 6o ?TTfB @ 6o ?T`B @ 01 ?T`B @ 01 ?FFTfB @ 6o ?T`B @ 01 ?   @ # lW   ȜȜ?   W H @ 0޽h ? MMM̙f=  !D}(  D}n   D #"&y D <DW?F  O 3169(63%)   @` D <HW? F O 3249(65%)   @` D <,W?  O R-T Crash   @` D <,W?F,  L80(2%) @` D <W?, F L65(1%) @`  D <W?,  O Not Known   @`  D <W?F ,  O 1053(21%)   @`  D <W? F,  O 1085(22%)   @`  D <W? ,  Kother @`  D <W?F  N699(14%)   @` D <@Q?F  N608(12%)   @` D <GQ?  MFall>2m @` D <(IQ?F  P  @` D <XVQ?F  P  @` D <]Q?  UCause of Injury @`fB D 6o ?`B D 01 ?`B D 01 ?  `B D 01 ?, , fB D 6o ?fB D 6o ?`B D 01 ?`B D 01 ?FFfB D 6o ?`B D 01 ?   !D # l`Q   ȜȜ?   Q H D 0޽h ? MMM̙f     HA (  HAf  H #"9 H <nQ?   Q 3,896(78%)   @` H <vQ?   U Yes 3,916(78%) @` H <~Q?  Q 1,105(22%)   @` H <Q?  \No/Not Known1,091(22%) @` H <Q?   P  @` H <Q?  XBrain CT Scan Done @`fB H 6o ?`B  H 01 ?  fB  H 6o ?fB  H 6o ?`B  H 01 ?  fB  H 6o ?`B H 01 ?   H # lQ   ȜȜ?   Q H H 0޽h ? MMM̙f  |,AL(  L~   AL #"6* yDDDDDDD b .L <,Q?`- K22% @` ,L <Q?`- K23% @` *L <4Q?- NNormal @` L <Q?`  K23% @` L < 1cm @` L <Q?`  K13% @` L <Q? ` K12% @` L <Q?  S Evacuated H   @` L <HQ?`=   K27% @` L <Q?= `  K27% @` L <Q?=   Non evacuated haematoma  @` L <ش7?` =  K15% @` L <7? `=  K14% @` L <7? =  OShift>5 @` L <D7?`   K32% @` L <7? `  K31% @`  L <(7?   KSAH @`  L <7?`q  K24% @`  L <7?q`  K23% @`  L <H7?q  $3rd V and basal cistern obliteration,% " @`  L <7?`-q K28% @` L <x?-`q K29% @` L < ?-q {1 petechial Hrrge @` L <$ ?` IP @` L <?` IC @` L <? WCT Scan Results @`fB L 6o ?`B L 01 ?--`B L 01 ?qq`B L 01 ?  `B  L 01 ?  `B !L 01 ?= = `B "L 01 ?  `B #L 01 ?fB $L 6o ?  fB %L 6o ? `B &L 01 ? `B 'L 01 ?`` fB (L 6o ? `B +L 01 ? ;L # lD&   ȜȜ?    H L 0޽h ? MMM̙f2  Pr(  Pr P S $1   P # l1   ȜȜ?    H P 0޽h ? MMM̙f*  (G`j(  `r ` S 88S    z    G` #"2&DDDDDD  .` <4??I r X687/1972(34.8%)  @` ,` <?Ir W785/1972(39.8%) @` *` <?Ir PGCS(3-8)   @` ` <Z?  W893/4979(17.9%) @` ` <\? X1052/4985(21.1%) @` ` <i? ZAll patients 95%CI @` ` <k?  W388/2077(18.7%) @` ` <t?  W517/2114(24.5%) @` ` <X|?  ]>3<8h X2 6.03,p=0.005 @` ` <,?C   U 296/1560(19%) @` ` <\?C   X308/15309(20.14) @` ` <,?C   M>1<3h @` ` <? C  X 209/1342(15.6%) @` ` <?C  X 227/1341(16.9%) @`  ` <?C  mTime since Injury <1h& @`  ` <ļ?  U 63/1531(4.1%) @`  ` <,ű? U 62/1460(4.2%) @`  ` <ͱ? S Mild(13-14)   @`  ` <α?r  V143/1476(9.7%) @` ` <ֱ?r W205/1553(13.2%0 @` ` <8߱?r WModerate (9-12) @` ` <?  I VP=(5001)   @` ` <? I X C n=(5007)   @` ` <l? I ]Injury severity @`fB ` 6o ?   `B ` 01 ?r r`B ` 01 ? `B ` 01 ? `B  ` 01 ?C C `B !` 01 ?  `B "` 01 ? fB $` 6o ? fB %` 6o ? `B &` 01 ? `B '` 01 ? fB (` 6o ?   `B +` 01 ?I IH ` 0޽h ? MMM̙fa   ( 1 @` h < ,?`  V144/500(28.8%) @` h <.?p` V137/486(28.2%) @` h <=?p S Evacuated H   @` h <C?`C  W322/1050(30.7%) @` h <@M?pC ` W366/1061(34.5%) @` h <8O?C p WNon evacuated H @` h <]?` C  V269/579(46.5%) @` h <@e?p `C  V279/556(50.2%) @` h <`? pC  R Shift >5mm   @` h <Hu?`   W378/1231(30.7%) @` h <l~?p `  W406/1226(33.1%) @`  h <? p  KSAH @`  h <̍?`   W 381/920(41.4%) @`  h <\?p`  W 396/906(43.7%) @`  h <T?p  #Obliteration 3rd V or basal cistern,$  @`  h <?`  W270/1098(24.6%) @` h <?p` W313/1139(27.5%) @` h <?p One or more petechial  @` h <ܿ?`P  ]P n=3896 32/878(3.6%) @` h <?pP` ^CS n=3916 42/897(4.7%) @` h <ɲ?Pp R Normal Ct   @`fB h 6o ?P P`B h 01 ? `B h 01 ? `B h 01 ?  `B  h 01 ?  `B !h 01 ?C C `B "h 01 ? `B #h 01 ? fB $h 6o ? fB %h 6o ?P`B &h 01 ?pPp`B 'h 01 ?`P`fB (h 6o ? P H h 0޽h ? MMM̙f   T$(  Tr T S ɲ    r T S |  H T 0޽h ? MMM̙f[   0X(  Xr X S      X 0@` UCorticosteroids should not be used routinely to use had injury whatever the severity.V 2VH X 0޽h ? 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        $  . .C2 >m(CLINICALLY SIGNIFICANT HEAD INJURY (MRC           . .62 hCRASH TRIAL):RANDOMISED PLACEBOe     . . 2 h0- . .2 BCONTROLLED TRIAL  . .2 > Dr. Hussein   . .2  Ssenyonjo . .(2 87Resident, Neurosurgery    . .2 brMulago  . .2 bHospital .--"System 0-&TNPP &՜.+,0    FOn-screen ShowoA.E.S NilePower) Arial WingdingsTimes New RomanArtsyEFFECT OF INTRAVENOUS CORTICOSTEROIDS ON DEATH WITHIN 14 DAYS IN 10,008 ADULTS WITH CLINICALLY SIGNIFICANT HEAD INJURY (MRC CRASH TRIAL):RANDOMISED PLACEBO-CONTROLLED TRIAL Dr. Hussein Ssenyonjo Resident, Neurosurgery Mulago Hospital SummaryPatients and methods ProceduresStatistical analysisResultsBaseline characteristicsBaseline characteristics-contBaseline characteristics-contBaseline characteristics-contBaseline characteristics-contBaseline characteristics-contBaseline characteristics-cont=Effects of CS allocation on death in 2wks,by injury severityQEffects of CS allocation on death from all causes in 2 weeks by CT scan results.Comment on results Conclusion  Fonts UsedDesign Template Slide Titles_7KapurGKapurG  !"#$%'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)PicturesKCurrent UserSummaryInformation($=PowerPoint Document(&DocumentSummaryInformation8