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Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury
Author(s)
SingHealth Duke-NUS Academic Medical Centre
Yanan Zhu
Singapore Clinical Research Institute
Quan Wang
Capital Medical University
Paula Caporal
Johns Hopkins University
Juan D. Roa
Universidad El Bosque
Freddy Israel Pantoja Chamorro
University of Nariño
Thelma Elvira Terán Miranda
Hongxing Dang
Children's Hospital of Chongqing Medical University
Chin Seng Gan
University of Malaya
Qalab Abbas
Aga Khan University
Ivan J. Ardila
Mohannad Antar
National Guard Health Affairs
Jesús Domínguez-Rojas
Instituto Nacional de Salud del Niño
María Miñambres Rodríguez
Hospital Universitario Virgen de la Arrixaca
Natalia Zita Watzlawik
Garrahan Hospital
Natalia Elizabeth Gómez Arriola
Adriana Yock‐Corrales
Costa Rican Department of Social Security
Rubén Eduardo Lasso Palomino
Fundación Valle del Lili
Ming Mei Xiu
Children's Hospital of Fudan University
Jacqueline Soo May Ong
National University of Singapore
Hiroshi Kurosawa
Kobe Children's Hospital
Gabriela Aparicio
Hospital de Niños Superiora Sor María Ludovica
Chun‐Feng Liu
China Medical University
Rujipat Samransamruajkit
Chulalongkorn University
Juan Camilo Jaramillo-Bustamante
Universidad de Antioquia
Nattachai Anantasit
Mahidol University
Yek Kee Chor
Sarawak General Hospital
Deborah M. Turina
Hospital General de Niños Ricardo Gutierrez
Pei Chuen Lee
National University of Malaysia
Marisol Fonseca Flores
Mexican Social Security Institute
J. Pilar Orive
BioCruces Health research Institute
Jing Wen
KK Women's and Children's Hospital
Sebastián González‐Dambrauskas
Universidad de la República de Uruguay
Jan Hau Lee
SingHealth
Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pediátrica de Latinoamérica (LARed)
Yasser Kazzaz
Jian Ji
Suyun Qian
Lijia Fan
Olive Pei Ee Lee
Soo Lin Chuah
Kai You
Tao Zhang
Deiby Lasso Noguera
Esteban Cerón
Andrea Leal Barceló
Susana Reyes
Cesia J Ortega Ocas
Date Issued
11 de marzo de 2025
Type
Article
Volume
8
Issue
3
Series/Report No.
JAMA Network Open
Start Page
e250438
End Page
e250438
ISSN
2574-3805
Abstract
Importance: The use of hypertonic saline (HTS) vs mannitol in the control of elevated intracranial pressure (ICP) secondary to neurotrauma is debated. Objective: To compare mortality and functional outcomes of treatment with 3% HTS vs 20% mannitol among children with moderate to severe traumatic brain injury (TBI) at risk of elevated ICP. Design, Setting, and Participants: This prospective, multicenter cohort study was conducted between June 1, 2018, and December 31, 2022, at 28 participating pediatric intensive care units in the Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pediátrica de Latinoamérica (LARed) in Asia, Latin America, and Europe. The study included children (aged <18 years) with moderate to severe TBI (Glasgow Coma Scale [GCS] score ≤13). Exposure: Treatment with 3% HTS compared with 20% mannitol. Main Outcomes and Measures: Multiple log-binomial regression analysis was performed for mortality, and multiple linear regression analysis was performed for discharge Pediatric Cerebral Performance Category (PCPC) scores and 3-month Glasgow Outcome Scale-Extended Pediatric Version (GOS-E-Peds) scores. Inverse probability of treatment weighting was also performed using the propensity score method to control for baseline imbalance between groups. Results: This study included 445 children with a median age of 5.0 (IQR, 2.0-11.0) years. More than half of the patients (279 [62.7%]) were boys, and 344 (77.3%) had severe TBI. Overall, 184 children (41.3%) received 3% HTS, 82 (18.4%) received 20% mannitol, 69 (15.5%) received both agents, and 110 (24.7%) received neither agent. The mortality rate was 7.1% (13 of 184 patients) in the HTS group and 11.0% (9 of 82 patients) in the mannitol group (P = .34). After adjusting for age, sex, presence of child abuse, time between injury and hospital arrival, lowest GCS score in the first 24 hours, and presence of extradural hemorrhage, no between-group differences in mortality, hospital discharge PCPC scores, or 3-month GOS-E-Peds scores were observed. Conclusions and Relevance: In this cohort study of children with moderate to severe TBI, the use of HTS was not associated with increased survival or improved functional outcomes compared with mannitol. Future large multicenter randomized clinical trials are required to validate these findings.
Keywords