Hypertonic Saline Resuscitation for Traumatic Brain Injury?

Abstract

Head injury is common in patients with major trauma (50% of 500 major trauma patients admitted to the Alfred Trauma Centre, Melbourne, Australia, during 1999). It has been estimated that 10000 people annually in Australia (population 19 million) are disabled as a result of head injury and 1500 are markedly disabled [1]. Despite best management, these head injured patients have a high mortality with only 50–65% survival reported from Europe and USA [2, 3]. Survival may be better in Australia where there are less penetrating injuries, and 69% survival was reported recently in the state of New South Wales (NSW) [4]. Seventy nine percent of road trauma patients who die after the arrival of ambulance services in the state of Victoria, Australia have a head injury, and in 58% the head is the major site [5]. Head injured survivors also have a high morbidity with 12–14% reported either severely disabled or vegetative. These patients are expensive, and in Victoria survivors of severe head injury are estimated each to have lifetime associated costs of $500–750000 (Transport Accident Commission, Melbourne, 1999, personal communication). An intervention which might improve outcome in head injured patients has potential to produce large social benefits and cost savings to the community.