| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
a Child Health Monitoring Unit, Department of
Epidemiology and Public Health, Institute of Child Health, University
of London, UK, b Cochrane
Centre, Summertown Pavilion, Middle Way, Oxford, UK
Correspondence to: Dr Ian Roberts, Child Health Monitoring Unit, Department of Epidemiology and Public Health, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. Telephone 0044 171 242 9789; fax 0044 171 242 2723.
Received 17 October 1997 and in revised form 26 February 1998;
Accepted 5 March 1998
OBJECTIVES
To assess the effectiveness of
interventions routinely used in the intensive care management of severe
head injury, specifically, the effectiveness of hyperventilation,
mannitol, CSF drainage, barbiturates, and corticosteroids.
METHODSSystematic review of all unconfounded
randomised trials, published or unpublished, that were available by
August 1996.
RESULTSNone of the interventions has been
reliably shown to reduce death or disability after severe head injury.
One trial of hyperventilation was identified of 77 participants. The
relative risk for death was 0.73 (95% confidence interval (95% CI)
0.36-1.49), and for death or disability it was 1.14 (95% CI
0.82-1.58). One trial of mannitol was identified of 41 participants.
The relative risk for death was 1.75 (95% CI 0.48-6.38), no data were
available for disability. No randomised trials of CSF drainage were
identified. Two randomised trials of barbiturate therapy were
identified, including 126 participants. The pooled relative risk for
death was 1.12 (95% CI 0.81-1.54). Disability data were available for one trial. The relative risk for death or disability was 0.96 (95% CI
0.62-1.49). Thirteen randomised trials of corticosteroids were
identified, comprising 2073 participants. The pooled relative risk for
death was 0.95 (0.84 to 1.07) and for death or disability it was 1.01 (95% CI 0.91 to 1.11). On the basis of the currently available
randomised evidence, for every intervention studied it is impossible to
refute either a moderate increase or a moderate decrease in the risk of
death or disability.
CONCLUSIONExisting trials have been too small to
support or refute the existence of a real benefit from using
hyperventilation, mannitol, CSF drainage, barbiturates, or
corticosteroids. Further large scale randomised trials of these
interventions are required.
This article has been cited by other articles:
|
|
 |
|
  G. Chen, J. Shi, W. Jin, L. Wang, W. Xie, J. Sun, and C. Hang Progesterone Administration Modulates TLRs/NF-{kappa}B Signaling Pathway in Rat Brain after Cortical Contusion Ann. Clin. Lab. Sci., January 1, 2008; 38(1): 65 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Roberts, H. Shakur, P. Edwards, D. Yates, and P. Sandercock Trauma care research and the war on uncertainty BMJ, November 12, 2005; 331(7525): 1094 - 1096. [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Wright, J. C. Ritchie, R. E. Mullins, A. L. Kellermann, and D. D. Denson Steady-State Serum Concentrations of Progesterone Following Continuous Intravenous Infusion in Patients With Acute Moderate to Severe Traumatic Brain Injury J. Clin. Pharmacol., June 1, 2005; 45(6): 640 - 648. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Stocchetti, A. I.R. Maas, A. Chieregato, and A. A. van der Plas Hyperventilation in Head Injury: A Review Chest, May 1, 2005; 127(5): 1812 - 1827. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. J. Clayton, R. J. Nelson, and A. R. Manara Reduction in mortality from severe head injury following introduction of a protocol for intensive care management Br. J. Anaesth., December 1, 2004; 93(6): 761 - 767. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Warner and C. O. Borel Treatment of Traumatic Brain Injury: One Size Does Not Fit All Anesth. Analg., October 1, 2004; 99(4): 1208 - 1210. [Full Text] [PDF]
|
|
|
|
|
|
I. Roberts and K. Abbasi War on the roads: two years on BMJ, April 10, 2004; 328(7444): 845 - 845. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Tolias and J. Wasserberg Critical decision making in severe head injury management Trauma, October 1, 2002; 4(4): 211 - 221. [Abstract] [PDF]
|
|
|
|
|
|
J. Wasserberg Treating head injuries BMJ, August 31, 2002; 325(7362): 454 - 455. [Full Text] [PDF]
|
|
|
|
|
|
K. Dickinson, F. Bunn, R. Wentz, P. Edwards, and I. Roberts Size and quality of randomised controlled trials in head injury: review of published studies BMJ, May 13, 2000; 320(7245): 1308 - 1311. [Abstract] [Full Text]
|
|
|
|
|
|
P. Alderson and I. Roberts Should journals publish systematic reviews that find no evidence to guide practice? Examples from injury research BMJ, February 5, 2000; 320(7231): 376 - 377. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
