New research warrants caution when applying common therapy to children with severe, traumatic brain injury



    TORONTO, June 4 /CNW/ - An international team of researchers from 17
centres led by a scientist at The Hospital for Sick Children (SickKids) has
discovered that the common practice of cooling paediatric patients after
traumatic brain injury does not improve the neurological outcome of patients
and may actually increase mortality. Their research is reported in the June
issue of The New England Journal of Medicine.
    Many paediatric centres currently use hypothermia therapy to treat
patients with severe traumatic brain injury. Cooling is used to help prevent
swelling of the brain and a build up of intracranial pressure, which can
prohibit oxygen from reaching the brain and exacerbate the injury.
    The randomized controlled trial is the largest study of its kind ever
published and the first collaborative study of children with head injury among
international paediatric intensive care units. It involved 225 children in 17
centres in Canada, France and the United Kingdom. Children with severe
traumatic brain injury were assigned to either hypothermia therapy (32.5
degrees Celsius for 24 hours) initiated within eight hours after injury, or to
normothermia (37.0 degrees Celsius), normal body temperature, and were
followed for up to 12 months after the therapy. At the six-month assessment,
32 of 102 patients (31%) in the hypothermia group compared to 23 of 103 (22%)
in the normothermia group exhibited a severe disability, persistent vegetative
state or died. There were 23 deaths in the hypothermia group and 14 deaths in
the normothermia group.
    "We were very surprised by these findings, since preliminary research in
adults with traumatic brain injury had demonstrated the potential benefit of
hypothermia therapy," says the lead author of the study, Dr. Jamie Hutchison,
staff physician and Director of Research, Department of Critical Care Medicine
at SickKids. "While death rates in both groups were not statistically
different, the slightly higher mortality in the hypothermia group represents a
worrisome trend, which is why we advise that hypothermia therapy only be used
under special circumstances."
    Hutchison and his team suspect that hypothermia therapy might be more
effective if started earlier and if the patients are cooled for longer
durations, followed by a slower re-warming period. The study also proved that
hypothermia therapy is effective in lowering intracranial pressure in patients
exhibiting elevated levels, which Hutchison calls an exciting discovery.
    Given that traumatic brain injury is the most common cause of death and
acquired handicap in children, as reported by the National Centre for Health
Statistics, the discoveries are critical to efforts to inform clinical care
and improve patient outcomes. Moving forward, Hutchison is working toward
creating a therapy that could mimic the effects of cooling but that could be
administered on the scene by a paramedic so that a patient would benefit
immediately from its protective effects, greatly increasing the chance of
preventing swelling and further damage to the brain until such time as an
effective hypothermia therapy could begin.
    The study was supported by the Canadian Institutes of Health Research
(Canadian Neurotrauma Research Program), the Ontario Neurotrauma Foundation,
the Rick Hansen Foundation, the SickKids Foundation, the Physicians Services
Incorporated, Fonds de la Recherche en Santé du Quebec, and the Children's
Hospital of Eastern Ontario Research Institute. The trial was conducted by the
Canadian Critical Care Trials Group, an association of over 100 practitioners
and trainees in 30 critical care research programs that enhance understanding
of how complex disease processes can be safely modified or cured, with an aim
to improve patient outcomes.

    The Hospital for Sick Children (SickKids), affiliated with the University
of Toronto, is Canada's most research-intensive hospital and the largest
centre dedicated to improving children's health in the country. As innovators
in child health, SickKids improves the health of children by integrating care,
research and teaching. Our mission is to provide the best in complex and
specialized care by creating scientific and clinical advancements, sharing our
knowledge and expertise and championing the development of an accessible,
comprehensive and sustainable child health system. For more information,
please visit www.sickkids.ca. SickKids is committed to healthier children for
a better world.




For further information:

For further information: Janice Nicholson, The Hospital for Sick
Children, (416) 813-6684, janice.nicholson@sickkids.ca

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