In this the fifth article of the SOCRATES series we present reviews from the Cochrane Database of Systematic Reviews relating to head and spinal trauma that the working party felt were of particular relevance to Emergency Medicine practitioners. The methods of our review and the rationale for the forming the SOCRATES working party are as have previously been published.

HEAD TRAUMA

MANNITOL FOR ACUTE TRAUMATIC BRAIN INJURY

Mannitol is sometimes dramatically effective in reversing acute brain swelling, but its effectiveness in the on-going management of severe head injury remains open to controversy. The objectives of this paper were to assess different mannitol regimes and compare with other intra-cranial pressure lowering agents.

Results

Three randomised controlled trials in patients with acute brain injury. The studies involved a total of one hundred and seventy seven participants. One trial compared mannitol therapy to ‘standard care’ (relative risk (RR) for death  =  0.83; 95% CI 0.47;1.46). One trial compared mannitol to phenobarbital (RR for death  =  0.85; 95% CI 0.52;1.38). One trial tested the effectiveness of pre-hospital adminstration of mannitol against placebo (RR for death  =  1.59; 95% CI 0.44:5.79).

SOCRATES says

Mannitol therapy directed by intra-cranial pressure …