Hyperbaric
oxygen administration improved mortality but not good functional outcome
following closed head injury.
Clinical Bottom Line:
1.Hyperbaric
oxygen administration resulted in a significant reduction in mortality
following closed head injury, but not in the numbers of patients assessed to
have a good functional outcome.
Appraised
by: Mike Bennett, Dept. of Diving and
Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Tuesday, 6 April 1999
Clinical
Scenario: A patient with severe closed
head injury.
Three-part
Question: In patients with moderate to
severe closed head injury, does the administration of hyperbaric oxygen in
addition to all usual intensive treatment, result in any improvement in
mortality or functional outcome?
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Terms: head injury
The
Study:
Non-blinded randomised
controlled trial with intention-to-treat.
Patients with acute closed head
trauma with a Glasgow Coma Score of 9 or less for 6 hours.
Control group (N = 84; 82
analysed): Intensive neurosurgical care according to a comprehensive protocol.
No sham treatment.
Experimental group (N = 84; 84
analysed): As above with the addition of 100% oxygen breathing at 1.5ATA for 1
hour every 8 hours for a maximum of two weeks or until death or waking (average
no of treatments 21). Routine administration of Vitamin A.
The
Evidence:
|
Outcome |
Time
to Outcome |
Control
group |
HBO
group |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Death |
12
months |
0.317 |
0.167 |
47% |
0.150 |
7 |
|
95%
CI: |
|
|
|
7%
to 88% |
0.022
to 0.278 |
4
to 46 |
|
Favourable
outcome |
12
months |
0.537 |
0.524 |
2% |
0.013 |
77 |
|
95%
CI: |
|
|
|
-26%
to 31% |
-0.139
to 0.165 |
NNT=6
to INF NNH=7 to
INF |
Comments:
1. Study not blinded except to
outcome assessor.
2. Change in treatment with the
addition of myringotomy for last 37 hyperbaric patients.
3. Most improvement in survival
occurred in the group with initial GCS of 4 to 6 and with peak ICP greater than
20mmHg.
Expiry
date: September
2005
References:
1. Rockswold GL, Ford SE,
Anderson DC, Bergman TA, Sherman RE. Results of a prospective randomised trial
for treatment of severely brain-injured patients with hyperbaric oxygen. Journal
of Neurosurgery 1992; 76:929-934.
2. Rockswold GL, Ford SE. Preliminary results of a prospective randomized trial of treatment of severely brain-injured patients with hyperbaric oxygen. Minnesota Med 1985; 68:533-535.
