Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury
2
Issued Date
2025-03-03
Resource Type
eISSN
25743805
Scopus ID
2-s2.0-105000204275
Pubmed ID
40067302
Journal Title
JAMA network open
Volume
8
Issue
3
Rights Holder(s)
SCOPUS
Bibliographic Citation
JAMA network open Vol.8 No.3 (2025) , e250438
Suggested Citation
Chong S.L., Zhu Y., Wang Q., Caporal P., Roa J.D., Chamorro F.I.P., Teran Miranda T.E., Dang H., Gan C.S., Abbas Q., Ardila I.J., Antar M.A., Domínguez-Rojas J.A., Rodríguez M.M., Watzlawik N.Z., Gómez Arriola N.E., Yock-Corrales A., Lasso-Palomino R.E., Xiu M.M., Ong J.S.M., Kurosawa H., Aparicio G., Liu C., Samransamruajkit R., Jaramillo-Bustamante J.C., Anantasit N., Chor Y.K., Turina D.M., Lee P.C., Flores M.F., Pilar Orive F.J., Ng Pei Wen J., González-Dambrauskas S., Lee J.H. Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury. JAMA network open Vol.8 No.3 (2025) , e250438. doi:10.1001/jamanetworkopen.2025.0438 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/108557
Title
Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury
Author(s)
Chong S.L.
Zhu Y.
Wang Q.
Caporal P.
Roa J.D.
Chamorro F.I.P.
Teran Miranda T.E.
Dang H.
Gan C.S.
Abbas Q.
Ardila I.J.
Antar M.A.
Domínguez-Rojas J.A.
Rodríguez M.M.
Watzlawik N.Z.
Gómez Arriola N.E.
Yock-Corrales A.
Lasso-Palomino R.E.
Xiu M.M.
Ong J.S.M.
Kurosawa H.
Aparicio G.
Liu C.
Samransamruajkit R.
Jaramillo-Bustamante J.C.
Anantasit N.
Chor Y.K.
Turina D.M.
Lee P.C.
Flores M.F.
Pilar Orive F.J.
Ng Pei Wen J.
González-Dambrauskas S.
Lee J.H.
Zhu Y.
Wang Q.
Caporal P.
Roa J.D.
Chamorro F.I.P.
Teran Miranda T.E.
Dang H.
Gan C.S.
Abbas Q.
Ardila I.J.
Antar M.A.
Domínguez-Rojas J.A.
Rodríguez M.M.
Watzlawik N.Z.
Gómez Arriola N.E.
Yock-Corrales A.
Lasso-Palomino R.E.
Xiu M.M.
Ong J.S.M.
Kurosawa H.
Aparicio G.
Liu C.
Samransamruajkit R.
Jaramillo-Bustamante J.C.
Anantasit N.
Chor Y.K.
Turina D.M.
Lee P.C.
Flores M.F.
Pilar Orive F.J.
Ng Pei Wen J.
González-Dambrauskas S.
Lee J.H.
Author's Affiliation
King Abdullah Specialist Children’s Hospital - Riyadh
Ramathibodi Hospital
Children's Hospital of Chongqing Medical University
Children’s Hospital of Fudan University
Biocruces Bizkaia Instituto de Investigación Sanitaria
Universidad Icesi
Singapore Health Services
Beijing Children's Hospital, Capital Medical University
Hospital Nacional de Niños Dr. Carlos Sáenz Herrera
Universidad de la Republica Facultad de Medicina
Instituto Nacional de Salud del Nino, Lima
Universidad de Antioquia
Universidad de Nariño
The Aga Khan University
Hyogo Prefectural Kobe Children's Hospital
Hospital Clínico Universitario Virgen de la Arrixaca
Universiti Malaya
NUS Yong Loo Lin School of Medicine
Hospital de Ninos Sor Maria Ludovica
King Chulalongkorn Memorial Hospital
Hospital de Ninos Ricardo Gutierrez
KK Women's And Children's Hospital
Hospital de Pediatria SAMIC Prof. Dr. Juan P. Garrahan
Sarawak General Hospital
China Medical University Shenyang
Instituto Mexicano del Seguro Social
Johns Hopkins Bloomberg School of Public Health
Universiti Kebangsaan Malaysia
Pediatric Neurocritical Care
Hospital de Trauma
LARed Network
Singapore Clinical Research Institute
Pediatric Critical Care
Hospital del Niño Manuel Ascencio Villarroel
Ramathibodi Hospital
Children's Hospital of Chongqing Medical University
Children’s Hospital of Fudan University
Biocruces Bizkaia Instituto de Investigación Sanitaria
Universidad Icesi
Singapore Health Services
Beijing Children's Hospital, Capital Medical University
Hospital Nacional de Niños Dr. Carlos Sáenz Herrera
Universidad de la Republica Facultad de Medicina
Instituto Nacional de Salud del Nino, Lima
Universidad de Antioquia
Universidad de Nariño
The Aga Khan University
Hyogo Prefectural Kobe Children's Hospital
Hospital Clínico Universitario Virgen de la Arrixaca
Universiti Malaya
NUS Yong Loo Lin School of Medicine
Hospital de Ninos Sor Maria Ludovica
King Chulalongkorn Memorial Hospital
Hospital de Ninos Ricardo Gutierrez
KK Women's And Children's Hospital
Hospital de Pediatria SAMIC Prof. Dr. Juan P. Garrahan
Sarawak General Hospital
China Medical University Shenyang
Instituto Mexicano del Seguro Social
Johns Hopkins Bloomberg School of Public Health
Universiti Kebangsaan Malaysia
Pediatric Neurocritical Care
Hospital de Trauma
LARed Network
Singapore Clinical Research Institute
Pediatric Critical Care
Hospital del Niño Manuel Ascencio Villarroel
Corresponding Author(s)
Other Contributor(s)
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.