Surveys show that mannitol, hyperventilation, cerebrospinal fluid drainage, and barbiturates are commonly used in the United Kingdom, Europe, and the United States to treat traumatic brain injury.1 2 3 Yet the effects of such treatments are uncertain.

Traumatic brain injury is a major cause of death and disability worldwide. Every year at least 10 million people sustain a traumatic brain injury serious enough to result in death or admission to hospital.4 Bearing in mind that almost half of all patients with traumatic brain injury experience long term disability5 6 and that most injury occurs in young adults, the medical, social, and financial burden is clear.