title: Saline or albumin for fluid resuscitation in patients with traumatic brain injury.
abstract: BACKGROUND
  The Saline versus Albumin Fluid Evaluation study suggested that patients with traumatic brain injury resuscitated with albumin had a higher mortality rate than those resuscitated with saline. We conducted a post hoc follow-up study of patients with traumatic brain injury who were enrolled in the study.
  
  
  METHODS
  For patients with traumatic brain injury (i.e., a history of trauma, evidence of head trauma on a computed tomographic [CT] scan, and a score of < or =13 on the Glasgow Coma Scale [GCS]), we recorded baseline characteristics from case-report forms, clinical records, and CT scans and determined vital status and functional neurologic outcomes 24 months after randomization.
  
  
  RESULTS
  We followed 460 patients, of whom 231 (50.2%) received albumin and 229 (49.8%) received saline. The subgroup of patients with GCS scores of 3 to 8 were classified as having severe brain injury (160 [69.3%] in the albumin group and 158 [69.0%] in the saline group). Demographic characteristics and indexes of severity of brain injury were similar at baseline. At 24 months, 71 of 214 patients in the albumin group (33.2%) had died, as compared with 42 of 206 in the saline group (20.4%) (relative risk, 1.63; 95% confidence interval [CI], 1.17 to 2.26; P=0.003). Among patients with severe brain injury, 61 of 146 patients in the albumin group (41.8%) died, as compared with 32 of 144 in the saline group (22.2%) (relative risk, 1.88; 95% CI, 1.31 to 2.70; P<0.001); among patients with GCS scores of 9 to 12, death occurred in 8 of 50 patients in the albumin group (16.0%) and 8 of 37 in the saline group (21.6%) (relative risk, 0.74; 95% CI, 0.31 to 1.79; P=0.50).
  
  
  CONCLUSIONS
  In this post hoc study of critically ill patients with traumatic brain injury, fluid resuscitation with albumin was associated with higher mortality rates than was resuscitation with saline. (Current Controlled Trials number, ISRCTN76588266 [controlled-trials.com].).
authors.affiliation: ANZICS Clinical Trials Group, Level 3, 10 Ievers Terrace, Carlton, VIC 3053, Australia. j.myburgh@unsw.edu.au
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Robyn
authors.initials: R
authors.lastname: Norton
authors.forename: Nicole
authors.initials: N
authors.lastname: Bishop
authors.forename: Sing
authors.initials: S
authors.lastname: Kai Lo
authors.forename: Shirley
authors.initials: S
authors.lastname: Vallance
mesh_terms: D018806:APACHE; D000328:Adult; D000418:Albumins / Q000627:therapeutic use*; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011336:Probability; D012965:Sodium Chloride / Q000627:therapeutic use*
chemical_list: D000418:Albumins; D012965:Sodium Chloride