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      Fever Control Management Is Preferable to Mild Therapeutic Hypothermia in Traumatic Brain Injury Patients with Abbreviated Injury Scale 3–4: A Multi-Center, Randomized Controlled Trial

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          Abstract

          In our prospective, multi-center, randomized controlled trial (RCT)—the Brain Hypothermia (B-HYPO) study—we could not show any difference on neurological outcomes in patients probably because of the heterogeneity in the severity of their traumatic condition. We therefore aimed to clarify and compare the effectiveness of the two therapeutic temperature management regimens in severe (Abbreviated Injury Scale [AIS] 3–4) or critical trauma patients (AIS 5). In the present post hoc B-HYPO study, we re-evaluated data based on the severity of trauma as AIS 3–4 or AIS 5 and compared Glasgow Outcome Scale score and mortality at 6 months by per-protocol analyses. Consequently, 135 patients were enrolled. Finally, 129 patients, that is, 47 and 31 patients with AIS 3–4 and 36 and 15 patients with AIS 5 were allocated to the mild therapeutic hypothermia (MTH) and fever control groups, respectively.

          No significant intergroup differences were observed with regard to age, gender, scores on head computed tomography (CT) scans, and surgical operation for traumatic brain injury (TBI), except for Injury Severity Score (ISS) in AIS 5. The fever control group demonstrated a significant reduction of TBI-related mortality compared with the MTH group (9.7% vs. 34.0%, p = 0.02) and an increase of favorable neurological outcomes (64.5% vs. 51.1%, p = 0.26) in patients with AIS 3–4, although the latter was not statistically significant. There was no difference in mortality or favorable outcome in patients with AIS 5.

          Fever control may be considered instead of MTH in patients with TBI (AIS 3–4).

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          Author and article information

          Journal
          J Neurotrauma
          J. Neurotrauma
          neu
          Journal of Neurotrauma
          Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
          0897-7151
          1557-9042
          01 June 2016
          : 33
          : 11
          : 1047-1053
          Affiliations
          [ 1 ]Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital , Kagawa, Japan.
          [ 2 ]Department of Emergency Medicine, Tokuyama Central Hospital , Yamaguchi, Japan.
          [ 3 ]Advanced Medical Emergency and Critical Care Center, Yamaguchi University School of Medicine , Yamaguchi, Japan.
          [ 4 ]Department of Emergency Medicine, School of Medicine, Jikei University , Tokyo, Japan.
          [ 5 ] Yamaguchi Prefectural Grand Medical Center , Yamaguchi, Japan.
          Author notes
          Address correspondence to: Toru Hifumi, MD, Department of Emergency Disaster and Critical Care Medicine, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan

          E-mail: hifumitoru@ 123456gmail.com
          Article
          PMC4892213 PMC4892213 4892213 10.1089/neu.2015.4033
          10.1089/neu.2015.4033
          4892213
          26413933
          a9dd6aae-fa5d-4cd0-bd7d-d0e9b70b0fa8
          Copyright 2016, Mary Ann Liebert, Inc.
          History
          Page count
          Figures: 1, Tables: 7, References: 26, Pages: 7
          Categories
          Original Articles

          Abbreviated Injury Scale,heterogeneous pathophysiology,multi-center randomized controlled trial,therapeutic hypothermia,traumatic brain injury

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