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To the Editor: Dr Cooper and colleagues¹ found no benefit to prehospital administration of 250 mL of 7.5% hypertonic saline among patients with hypotension and severe traumatic brain injury. It is not clear, however, whether the trial had sufficient statistical power to detect a meaningful difference. The trial was designed to detect a 20% improvement in the conventional extended Glasgow Outcome Score (GOSE) with 80% power and an statistical value of .05. I do not think this is an ideal end point because I believe that most clinicians and patients would not view a change from death to persistent vegetative state or from persistent vegetative to severe disability as a treatment success.

A more important outcome would be the attainment of a functional neurological status. Other recent trials of brain injury have measured the proportion of patients with a favorable neurological outcome as the primary outcome. Given that in a . . . [Full Text of this Article]

David Zygun, MD, FRCPC
Departments of Critical Care Medicine and Clinical Neurosciences
University of Calgary
Calgary, Alberta

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