title: Hyperosmolar therapy in severe traumatic brain injury: a survey of emergency physicians from a large Canadian province.
abstract: BACKGROUND
  Worldwide, severe traumatic brain injury is a frequent pathology and is associated with high morbidity and mortality. Mannitol and hypertonic saline are therapeutic options for intracranial hypertension occurring in the acute phase of care. However, current practices of emergency physicians are unknown.
  
  
  METHODS
  We conducted a self-administered survey of emergency physicians in the province of Québec, Canada, to understand their attitudes surrounding the use of hyperosmolar solutions in patients with severe traumatic brain injury. Using information from a systematic review of hypertonic saline solutions and experts' opinion, we developed a questionnaire following a systematic approach (items generation and reduction). We tested the questionnaire for face and content validity, and test-retest reliability. Physicians were identified through the department head of each eligible level I and II trauma centers. We administered the survey using a web-based interface and planned email reminders.
  
  
  RESULTS
  We received 210 questionnaires out of 429 potentials respondents (response rate 49%). Most respondents worked in level II trauma centers (69%). Fifty-three percent (53%) of emergency physicians stated using hypertonic saline to treat severe traumatic brain injury. Most reported using hyperosmolar therapy in the presence of severe traumatic brain injury and unilateral reactive mydriasis, midline shift or cistern compression on brain computed tomography.
  
  
  CONCLUSIONS
  Hyperosmolar therapy is believed being broadly used by emergency physicians in Quebec following severe traumatic brain injury. Despite the absence of clinical practice guidelines promoting the use of hypertonic saline, a majority of them said to use these solutions in specific clinical situations.
authors.affiliation: Research Center of the Centre Hospitalier Universitaire (CHU) de Québec, Axe Santé des populations et pratiques optimales en santé (Population Health and Optimal health practices Research Unit), Traumatologie - Urgence - Soins Intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada; Department of Family and Emergency Medicine, Université Laval, Québec City, Québec, Canada.
authors.forename: Elyse
authors.initials: E
authors.lastname: Berger Pelletier
authors.affiliation: Research Center of the Centre Hospitalier Universitaire (CHU) de Québec, Axe Santé des populations et pratiques optimales en santé (Population Health and Optimal health practices Research Unit), Traumatologie - Urgence - Soins Intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada; Department of Family and Emergency Medicine, Université Laval, Québec City, Québec, Canada.
authors.forename: Marcel
authors.initials: M
authors.lastname: Émond
authors.affiliation: Research Center of the Centre Hospitalier Universitaire (CHU) de Québec, Axe Santé des populations et pratiques optimales en santé (Population Health and Optimal health practices Research Unit), Traumatologie - Urgence - Soins Intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada; Division of Critical Care, Department of Anesthesiology, Université Laval, Québec City, Québec, Canada; Department of Medicine, Université Laval, Québec City, Québec, Canad.
authors.forename: François
authors.initials: F
authors.lastname: Lauzier
authors.affiliation: Research Center of the Centre Hospitalier Universitaire (CHU) de Québec, Axe Santé des populations et pratiques optimales en santé (Population Health and Optimal health practices Research Unit), Traumatologie - Urgence - Soins Intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada; Department of Neurological Sciences, Université Laval, Québec City, Québec, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Savard
authors.affiliation: Research Center of the Centre Hospitalier Universitaire (CHU) de Québec, Axe Santé des populations et pratiques optimales en santé (Population Health and Optimal health practices Research Unit), Traumatologie - Urgence - Soins Intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada; Division of Critical Care, Department of Anesthesiology, Université Laval, Québec City, Québec, Canada.
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D019538:Health Care Surveys; D006801:Humans; D006982:Hypertonic Solutions / Q000627:therapeutic use*; D015601:Injury Severity Score; D010820:Physicians; D011792:Quebec / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D006982:Hypertonic Solutions
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