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2018-11-23T06:39:10Z

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'''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? 
'''Search 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:''' November 2021
'''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.



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