How effective are some common treatments for traumatic brain injury?

Surveys show that mannitol, hyperventilation, cerebrospinal fluid drainage, and barbiturates are commonly used in the United Kingdom, Europe, and the United States to treat traumatic brain injury.1 2 3 Yet the effects of such treatments are uncertain. Traumatic brain injury is a major cause of death and disability worldwide. Every year at least 10 million people sustain a traumatic brain injury serious enough to result in death or admission to hospital.4 Bearing in mind that almost half of all patients with traumatic brain injury experience long term disability5 6 and that most injury occurs in young adults, the medical, social, and financial burden is clear. The Cochrane Injuries Group maintains a specialised register of randomised controlled trials of interventions for traumatic brain injury and has searched extensively for trials evaluating the effects of mannitol, hyperventilation, cerebrospinal fluid drainage, and barbiturates. The group has also prepared, and regularly updates, systematic reviews to assess the effects of barbiturates,7 hyperventilation,8 and mannitol.9 In 1998 the Cochrane Injuries Group highlighted the absence of reliable evidence for the effectiveness of these four treatments10 when searches identified only three small trials of barbiturates,11 12 …