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Volume 28, Issue 147, May 2024

Management of acute Traumatic Brain Injury in emergency department: Systematic review

Dahian Abdullah Aldahian¹, Omar Saud Obaid Alharthi², Adel Ahmed Alzhrani², Tamim Khalid Abdullah Abdulrahim³

¹Saudi Board Certified Emergency Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
²Saudi Board Emergency Medicine, Saudi Board Certified Emergency Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
³Medical Intern, College of Medicine, Bisha University, Bisha, Saudi Arabia

ABSTRACT

Background: Adults who suffer from traumatic brain injury often die from it, become permanently disabled, and incur significant costs to the healthcare system. We aimed to compare the effects of hypertonic sodium and mannitol on intracranial pressure change from baseline, and significant adverse events in patients who have had acute traumatic brain injury. Method: The databases of Cochrane, EMBASE, CENTRAL, and PubMed were searched for published articles between 2008 and 2023. We looked for human researches. Bibliographies and recommendations for clinical practice were examined. Studies about the comparison between mannitol and HTS in randomized trials for people with acute traumatic brain injury were collected. Results: Six RCTs were included in the systematic review after duplicates and irrelevant studies were eliminated from the chosen publications. We looked at 336 patients in total from the six RCTs. ICP was lowered by 45% of the mean baseline values in patients receiving mannitol infusion for 60 minutes, compared to 35% of the baseline values in the HTS group. Mannitol was just as successful as HTS in lowering ICP, but neither drug was able to enhance brain metabolism. Conclusion: MTL was equally successful in lowering ICP as HTS was in the cases of cerebral ischemia, HTS demonstrated better result on cerebral perfusion, which could be helpful.

Keywords: Traumatic brain injury, elevated intracranial pressure, management, systematic review