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The addition of hyperbaric oxygen to neurosurgical care following acute traumatic head injury improved the Glasgow Coma Score and may reduce serum C-reactive protein
| Clinical Bottom Line: 1. The addition of HBOT to a standard neurosurgical regimen for the treatment of acute head injury reduced the serum level of C-reactive protein, but this difference was not statistically significant. 2. The same therapy reduced the Glasgow Coma Score significantly, but the actual functional benefit in an individual remains unclear. |
Citation/s:1. Xie Z, Zhuang M, Lin L, Xu H, Chen L, Hu, L. Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation: a randomly controlled study. Neural Regeneration Research 2007; 2(5):314-317 Lead author's name and fax: [| xzy3175@yahoo.com.cn]
Three-part Clinical Question: For patients with an acute traumatic head injury, does the addition of HBOT to standard neurosurgical care result in improved outcome? Search Terms: Head injuries, closed; C-reactive protein; Glasgow Coma Scale
The Study:Non-blinded randomised controlled trial with intention-to-treat. The Study Patients: Within 24 hours of a head injury and with C/T or MRI evidence of injury, GCS between 3 and 12 and no major chest or abdominal injury. Control group (N = 30; 30 analysed): Neurosurgical care including antibiotics, operation, dehydration, ICP control Experimental group (N = 30; 30 analysed): As above plus 100% oxygen at between 2 and 2.5 ATA for 70 to 80 minutes daily for ten days
The Evidence:
| Measure | Control Group | HBOT Group | Difference | 95% CI | ||
| ^ | Mean | SD | Mean | SD | ||
| GCS | 8.9 | 2.9 | 12.5 | 1.2 | 3.6 | 1.1 to 6.1 |
| Serum C-reactive protein (mg/L) | 47.8 | 20.1 | 23.61 | 10.76 | 24.160 | -110.5 to 158.8 |
Comments: 1. Unblinded study where the outcome assessors of GCS were aware of allocation. 2. Paper quotes the difference in C-reactive protein as significant, but this is not confirmed in our analysis. 3. Patients were not enrolled with very severe injury (GCS 12). 4. There does not appear to have been any deaths in this study. 5. The numbers of individuals making a good functional outcome is not recorded.
Appraised by: Mike BennettSydney ; Wednesday, 21 January 2009 Email: [| m.bennett@unsw.edu.au]
Kill or Update By: November 2021
