Mannitol vs. 3% NaCL in Management of Pediatric Severe Traumatic Brain Injury
Design: A retrospective, descriptive correlation design.
Setting: Level 1 pediatric trauma center in Southern California.
Patients: Children 8 to 18 years old admitted with isolated severe TBI (Glasgow Coma Scale score on admission 3-8) between January 2003 and January 2009. All these children had a documented abnormal head computed tomography scan (CT scan) on admission. Children with increase intracranial pressure were treated with either Mannitol, 3% NaCl, or combined therapy of Mannitol and 3% NaCL
Interventions: None.
Measurements: Children (n=96) admitted with isolated severe TBI had a median age of 13 years and documented brain injury on CT scan. The median GCS was 3 (range 3-8) on arrival to the Emergency room as well as at the time of ICU admission. Children were divided into 4 groups depending on the type of treatment used. Study outcome were neurological disposition status on discharge as measured using a modified Pediatric Cerebral Performance Category scale (PCPC) and Length of stay (LOS) in ICU.
Results: Significant relationship was documented between the type of hyperosmolar therapy used and LOS in ICU. Children who received Mannitol had the shortest LOS and the highest mortality rate of 80% while the group who received 3% NaCl had the longest LOS in ICU. The group who received combined therapy of Mannitol and 3% NaCl had the lowest mortality rate which may suggest of better modalities to manage increased ICP’s