Absence of evidence for the effectiveness of five interventions routinely used in the intensive care management of severe head injury: a systematic review
Open Access
- 1 November 1998
- journal article
- review article
- Published by BMJ in Journal of Neurology, Neurosurgery & Psychiatry
- Vol. 65 (5) , 729-733
- https://doi.org/10.1136/jnnp.65.5.729
Abstract
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. METHODS Systematic review of all unconfounded randomised trials, published or unpublished, that were available by August 1996. RESULTS None 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. CONCLUSION Existing 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.Keywords
This publication has 25 references indexed in Scilit:
- Die Geschichte der Stimmgabel - Teil 1: Die Erfindung der Stimmgabel, ihr Weg in der Musik und den NaturwissenschaftenLaryngo-Rhino-Otologie, 1997
- Clinical Neuro-Protection Trials in Severe Traumatic Brain Injury: Lessons from Previous StudiesJournal of Neurotrauma, 1997
- Global spine and head injury prevention project (SHIP)Surgical Neurology, 1992
- Aggravation of vasogenic cerebral edema by multiple-dose mannitolJournal of Neurosurgery, 1992
- The Tuning Fork RevisitedDiabetic Medicine, 1990
- OBSERVATIONS ON THE RINNE TESTThe Lancet, 1982
- The Early Descriptions of the So-called Tuning-Fork Tests of Weber, Rinne, Schwabach, and BingORL, 1975
- The Early Descriptions of the So-called Tuning-Fork Tests of Weber, Rinne, Schwabach, and BingORL, 1975
- Hyperventilation and Cerebral Blood FlowStroke, 1972
- VIBRATORY SENSE: A CRITICAL REVIEWBrain, 1966