Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma

A meta-analysis of controlled clinical studies

Charles E. Wade, George Kramer, James J. Grady, Timothy C. Fabian, Riad N. Younes

Research output: Contribution to journalArticle

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Abstract

Background. Individual trials of small-volume resuscitation of 7.5% NaCl (HS) with and without 6% dextran 70 (HSD) for the treatment of trauma and have failed to provide convincing evidence of efficacy. We performed a meta- analysis to evaluate the effects of HS and HSD on survival until discharge or for 30 days. We identified eight double-blinded, randomized controlled trials of HSD and six trials of HS. In all cases, administration of 250 ml of HSD or HS was compared with a control group administration of 250 ml of isotonic crystalloid for the treatment of hypotension either in the field or at admission to the emergency department. Methods. A fixed-effects meta-analysis was performed with the Mantel-Haenszel method of combining results from multiple studies. Results. Overall, HS was not effective in improving survival with a weighted mean difference in survival of the HS group versus the isotonic control group equal to 0.6%. The results with HSD were more positive, with an increase in survival in seven of eight trials. The mean difference in survival rates favoring HSD (n = 615) over controls (n = 618) was 3.5% (p = 0.14, two-tailed; p = 0.07, one-tailed). The odds ratio was estimated to be 1.20 in favor of HSD with a 95% confidence interval of 0.94 to 1.57. Conclusions. The meta-analysis of the available data shows that HS is not different from the standard of care and that HSD may be superior.

Original languageEnglish (US)
Pages (from-to)609-616
Number of pages8
JournalSurgery
Volume122
Issue number3
DOIs
StatePublished - Sep 1997

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Dextrans
Meta-Analysis
Wounds and Injuries
Control Groups
Standard of Care
Resuscitation
Hypotension
Hospital Emergency Service
Randomized Controlled Trials
Odds Ratio
Confidence Intervals
Therapeutics
Clinical Studies

ASJC Scopus subject areas

  • Surgery

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Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma : A meta-analysis of controlled clinical studies. / Wade, Charles E.; Kramer, George; Grady, James J.; Fabian, Timothy C.; Younes, Riad N.

In: Surgery, Vol. 122, No. 3, 09.1997, p. 609-616.

Research output: Contribution to journalArticle

Wade, Charles E. ; Kramer, George ; Grady, James J. ; Fabian, Timothy C. ; Younes, Riad N. / Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma : A meta-analysis of controlled clinical studies. In: Surgery. 1997 ; Vol. 122, No. 3. pp. 609-616.
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abstract = "Background. Individual trials of small-volume resuscitation of 7.5{\%} NaCl (HS) with and without 6{\%} dextran 70 (HSD) for the treatment of trauma and have failed to provide convincing evidence of efficacy. We performed a meta- analysis to evaluate the effects of HS and HSD on survival until discharge or for 30 days. We identified eight double-blinded, randomized controlled trials of HSD and six trials of HS. In all cases, administration of 250 ml of HSD or HS was compared with a control group administration of 250 ml of isotonic crystalloid for the treatment of hypotension either in the field or at admission to the emergency department. Methods. A fixed-effects meta-analysis was performed with the Mantel-Haenszel method of combining results from multiple studies. Results. Overall, HS was not effective in improving survival with a weighted mean difference in survival of the HS group versus the isotonic control group equal to 0.6{\%}. The results with HSD were more positive, with an increase in survival in seven of eight trials. The mean difference in survival rates favoring HSD (n = 615) over controls (n = 618) was 3.5{\%} (p = 0.14, two-tailed; p = 0.07, one-tailed). The odds ratio was estimated to be 1.20 in favor of HSD with a 95{\%} confidence interval of 0.94 to 1.57. Conclusions. The meta-analysis of the available data shows that HS is not different from the standard of care and that HSD may be superior.",
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