BMJ  2007;334:392-394 (24 February), doi:10.1136/bmj.39118.480023.BE

Feature

Research ethics

Doubts over head injury studies

London School of Hygiene and Tropical Medicine, London WC1E 7HT

Patients are receiving treatment that may be unsound as investigations by Ian Roberts and colleagues raise questions about whether influential trials of high dose mannitol ever took place

The first 150 words of the full text of this article appear below.

Each year, worldwide, many thousands of people are treated in emergency departments for head injuries. Mannitol is an osmotic diuretic that is believed to reduce intracranial pressure after head injury and may improve patient outcome. Between 2001 and 2004, a Brazilian neurosurgeon Julio Cruz and colleagues published three clinical trials comparing high dose and conventional dose mannitol in the treatment of head injury (table).¹²³ No other trials had examined this question.

The results showed that high dose mannitol greatly reduced death and disability six months after the head injury. A Cochrane systematic review that included these trials concluded: "high dose mannitol seems to be preferable to conventional dose mannitol in the acute management of comatose patients with severe head injury."⁴ However, one of the trials was accompanied by an editorial that questioned the reliability and validity of the results, calling for further multicentre studies.⁵ A subsequent investigation by the . . . [Full text of this article]

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This article has been cited by other articles:

• Ker, K., Perel, P., Blackhall, K., Roberts, I. (2008). How effective are some common treatments for traumatic brain injury?. BMJ 337: a865-a865 [Full text]  
• Young, C., Godlee, F. (2007). Managing suspected research misconduct. BMJ 334: 378-379 [Full text]  

Rapid Responses:

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what were the co-authors and journal editors thinking

Dan Dedman
bmj.com, 23 Feb 2007 [Full text]

Research misconduct is not exclusive to conventional medicine

Leslie B Rose
bmj.com, 2 Apr 2007 [Full text]

High-dose Mannitol in Head Injury: Review practice and recall patients for mandatory follow-up

Nosa A Akporehwe
bmj.com, 26 Feb 2007 [Full text]

High Dose Mannitol - The Brain Trauma Foundation Treatment Guidelines

Nancy A. Carney, PhD
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Make the best use of the PMID

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bmj.com, 30 Jan 2008 [Full text]

Doubts over high dose Mannitol therapy in head trauma

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