 |
|
The Role of Hypothermia in the Management of Severe Brain Injury
A Meta-analysis
Odette A. Harris, MD, MPH;
John M. Colford, Jr, MD, PhD;
Matthew C. Good;
Paul G. Matz, MD
Arch Neurol. 2002;59:1077-1083.
Context Hypothermia is utilized in the management of severe traumatic brain
injury despite the lack of unequivocal evidence supporting its use. Because
of its widespread use, the effects of hypothermia are a concern.
Objective To determine the effectiveness of hypothermia in the management of severe
brain injury.
Data Sources Two investigators working independently abstracted data in a blinded
fashion from studies identified using multiple literature databases, including
MEDLINE, Ovid, PubMed, the Cochrane Database of Systematic Reviews, EMBASE,
and the abstract center for the American Association of Neurological Surgery
and the Congress of Neurological Surgery, as well as the bibliographies of
these articles. Additionally, experts in the field of hypothermia and neurotrauma
provided additional references.
Study Selection Seven studies met predetermined inclusion criteria: (1) the study was
a randomized clinical trial comparing the efficacy of hypothermia vs normothermia
in patients with posttraumatic head injury, (2) only subjects aged 10 years
or older were included in the study, and (3) relative risks (odds ratios [ORs],
cumulative incidence, or incidence density measures) and 95% confidence intervals
(CIs) or weighted mean differences and 95% CIs could be calculated from the
data presented in the article. These criteria were applied in a blinded fashion
by 2 independent investigators.
Data Extraction No single outcome variable was evaluated in all studies. The following
outcome variables were assessed: intracranial pressure, Glasgow Outcome Scale
score, pneumonia, cardiac arrhythmia, prothrombin time, and partial thromboplastin
time. Either ORs or weighted mean differences (when the data provided did
not permit calculation of an OR) comparing the effects of hypothermia vs normothermia
were calculated from the data provided.
Data Synthesis The weighted mean difference (hypothermia - normothermia) for
intracranial pressure was -2.98 mm Hg (95% CI, –7.58 to 1.61; P = .2). The OR (hypothermia vs normothermia) for Glasgow
Outcome Scale score was 0.61 (95% CI, 0.26-1.46; P
= .3). The OR for pneumonia was 2.05 (95% CI, 0.79-5.32; P = .14). The OR for cardiac arrhythmia was 1.27 (95% CI, 0.38-4.25; P = .7). The weighted mean difference for prothrombin time
was 0.02 seconds (95% CI, –0.07 to 0.10; P
= .7). The weighted mean difference for partial thromboplastin time was 2.22
seconds (95% CI, 1.73-2.71; P<.001).
Conclusions This meta-analysis of randomized controlled trials suggests that hypothermia
is not beneficial in the management of severe head injury. However, because
hypothermia continues to be used to treat these injuries, additional studies
are justified and urgently needed.
From the Department of Neurosurgery, Stanford University Medical Center,
Stanford, Calif (Drs Harris and Matz); and the Division of Public Health Biology
and Epidemiology, School of Public Health, University of California, Berkeley
(Dr Colford and Mr Good).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Therapeutic Hypothermia: Past, Present, and Future
Varon and Acosta
Chest 2008;133:1267-1274.
ABSTRACT
| FULL TEXT
Prolonged Therapeutic Hypothermia After Traumatic Brain Injury in Adults: A Systematic Review
McIntyre et al.
JAMA 2003;289:2992-2999.
ABSTRACT
| FULL TEXT
OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
Evid. Based Nurs. 2003;6:e1-1.
FULL TEXT
|
