Evidence map›Paper›PMID 29905883›Full record

SynthesisNeurosurgical review2019

Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials.

Jiajie Gu, Haoping Huang, Yuejun Huang, Haitao Sun, Hongwu Xu

Abstract readComparative StudyMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Neurosurgical review, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 7 pooled it
8.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 7 syntheses or guidelines pooled it, 96 citations in OpenAlex.

  1. Pooled it
  2. Therapeutic comparison of hypertonic saline and mannitol in pediatric intracranial hypertension: a systematic review and meta-analysis.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2025
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  8. Comparison of equiosmolar dose of hyperosmolar agents in reducing intracranial pressure-a randomized control study in pediatric traumatic brain injury.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2019
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  13. A Rare Cause of Headache and an Unorthodox Transfer: A Case Report.Clinical practice and cases in emergency medicine · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Jiajie GuCollege of Medicine, Shantou University, Shantou, Guangdong, China.
Haoping HuangCollege of Medicine, Shantou University, Shantou, Guangdong, China.
Yuejun HuangTransforming Medical Center, Second Affiliated Hospital of Medical College of Shantou University, North Dongxia Rd, Shantou, 515041, Guangdong, China.
Haitao SunDepartment of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
Hongwu XuDepartment of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Changping Rd, Shantou, 515041, Guangdong, China. hwxu@qq.com.ORCID http://orcid.org/0000-0002-2857-1556
Shantou University · CNZhujiang Hospital · CN

Funding

Key, the Pearl River S&T Nova Program of Guangzhou 201710010047National Natural Science Foundation of China (CN) 31300927the Medical Scientific Research Foundation of Guangdong Province A2016496
6 · The paper itself

Abstract

Hyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. We conducted a systematic search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Wan Fang Data, VIP Data, SinoMed, and China National Knowledge Infrastructure (CNKI) databases. Studies were included or not based on the quality assessment by the Jadad scale and selection criteria. Twelve RCTs with 438 patients were enrolled for the meta-analysis. The comparison of HS and mannitol indicated that they were close in field of improving function outcome (RR = 1.17, 95% CI 0.89 to 1.54, p = 0.258) and reducing intracranial pressure (MD = - 0.16, 95% CI: - 0.59 to 0.27, p = 0.473) and mortality (RR = 0.78, 95% CI 0.53 to 1.16, p = 0.216). The pooled relative risk of successful ICP control was 1.06 (95% CI: 1.00 to 1.13, p = 0.044), demonstrating that HS was more effective than mannitol in ICP management. Both serum sodium (WMD = 5.30, 95% CI: 4.37 to 6.22, p < 0.001) and osmolality (WMD = 3.03, 95% CI: 0.18 to 5.88, p = 0.037) were increased after injection of hypertonic saline. The results do not lend a specific recommendation to select hypertonic saline or mannitol as a first-line for the patients with elevated ICP caused by TBI. However, for the refractory intracranial hypertension, hypertonic saline seems to be preferred.

Indexed as

Brain Injuries, TraumaticDiuretics, OsmoticHumansIntracranial HypertensionMannitolRandomized Controlled Trials as TopicSaline Solution, HypertonicDiuretics, OsmoticMannitolSaline Solution, HypertonicHypertonic salineIntracranial hypertensionIntracranial pressureMannitolMeta-analysisTraumatic brain injury

Identifiers

PMID29905883
OpenAlexW2807904518

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.