Which statement best captures guidelines for corticosteroids in acute TBI?

• A. They are routinely recommended to reduce edema.
• B. They are not recommended and may worsen outcomes.
• C. They are recommended only if hypotension is present.
• D. They prevent secondary brain injury in all cases.

Answer: (B)

Corticosteroids do not improve outcomes after acute traumatic brain injury and can cause harm. Large randomized trials, most notably the CRASH study, found that high‑dose steroids in head injury were associated with higher mortality and more complications such as infection and hyperglycemia. Because of this, guidelines recommend against routine use of corticosteroids for acute TBI to reduce edema or prevent secondary brain injury. They are not restricted to a specific condition like hypotension, and they do not reliably prevent secondary injury in all cases. In short, the risks outweigh any unproven benefit, so steroids are not recommended in the acute TBI setting.