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Saline, Not Albumin, for Patients with Head Injury
Albumin use is associated with a significantly higher death rate.
The Saline versus Albumin Fluid Evaluation (SAFE) study was a randomized, double-blind comparison of saline and albumin in a heterogeneous population of intensive care unit patients. The study showed no difference in outcomes between treatment groups but suggested an increased death rate in patients with traumatic brain injury who received albumin. However, the trial was not directed specifically toward patients with head injury.
Researchers reevaluated data from the SAFE study for patients with traumatic brain injury (SAFE-TBI study), using specific measures of injury severity, including Glasgow Coma Scale (GCS) score and intracranial pressure. In addition, whereas the original study measured outcomes up to 28 weeks after admission, this study measured outcomes (death and disability) at 24 months.
Of 460 patients with traumatic brain injury, 69% had severe injury (GCS score of 3–8). At 24 months, 33.2% of the albumin group had died, as compared to 20.4% of the saline group. This difference was due to a marked disparity in survival in the subgroup of patients with severe head injury; mortality rates were 41.8% in those treated with albumin and 22.2% in those treated with saline (relative risk, 1.88). Among survivors, neurologic outcomes were similar in the two treatment groups.
Comment: The albumin versus saline debate has been going on for a long time, and albumin has never been shown to be better, despite its much higher cost. In this study, albumin was associated with significantly worse outcomes. For patients with head injury, albumin should be allowed to gather dust in the pharmacy. The money would be better spent elsewhere.
— J. Stephen Bohan, MD, MS, FACP, FACEP
Published in Journal Watch Emergency Medicine September 28, 2007
Citation(s):
The SAFE Study Investigators. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med 2007 Aug 30; 357:874.
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