Difficulties in establishing the value of certain treatments for head injury are reviewed. An analysis of 1000 severely head injured patients, managed by varying methods in three different countries, showed that certain treatments were more often used in the most severely injured patients. Even when the severity of injury was taken account of, it appeared that the use of steroids and tracheostomy did not affect outcome; but that patients undergoing mechanical ventilation had outcomes which were worse than expected. The value of treatments proposed for severe head injury needs rigorous scrutiny.
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