{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T04:43:39Z","timestamp":1793940219200,"version":"4.8.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250039-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>The use of hypertonic saline (HTS) vs mannitol in the control of elevated intracranial pressure (ICP) secondary to neurotrauma is debated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250039-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare mortality and functional outcomes of treatment with 3% HTS vs 20% mannitol among children with moderate to severe traumatic brain injury (TBI) at risk of elevated ICP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250039-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This prospective, multicenter cohort study was conducted between June 1, 2018, and December 31, 2022, at 28 participating pediatric intensive care units in the Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pedi\u00e1trica de Latinoam\u00e9rica (LARed) in Asia, Latin America, and Europe. The study included children (aged &amp;amp;lt;18 years) with moderate to severe TBI (Glasgow Coma Scale [GCS] score \u226413).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250039-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Treatment with 3% HTS compared with 20% mannitol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250039-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Multiple log-binomial regression analysis was performed for mortality, and multiple linear regression analysis was performed for discharge Pediatric Cerebral Performance Category (PCPC) scores and 3-month Glasgow Outcome Scale\u2013Extended Pediatric Version (GOS-E-Peds) scores. Inverse probability of treatment weighting was also performed using the propensity score method to control for baseline imbalance between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250039-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study included 445 children with a median age of 5.0 (IQR, 2.0-11.0) years. More than half of the patients (279 [62.7%]) were boys, and 344 (77.3%) had severe TBI. Overall, 184 children (41.3%) received 3% HTS, 82 (18.4%) received 20% mannitol, 69 (15.5%) received both agents, and 110 (24.7%) received neither agent. The mortality rate was 7.1% (13 of 184 patients) in the HTS group and 11.0% (9 of 82 patients) in the mannitol group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.34). After adjusting for age, sex, presence of child abuse, time between injury and hospital arrival, lowest GCS score in the first 24 hours, and presence of extradural hemorrhage, no between-group differences in mortality, hospital discharge PCPC scores, or 3-month GOS-E-Peds scores were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250039-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study of children with moderate to severe TBI, the use of HTS was not associated with increased survival or improved functional outcomes compared with mannitol. Future large multicenter randomized clinical trials are required to validate these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.0438","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T11:13:15Z","timestamp":1741691595000},"page":"e250438","source":"Crossref","is-referenced-by-count":15,"title":["Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury"],"prefix":"10.1001","volume":"8","author":[{"given":"Shu-Ling","family":"Chong","sequence":"first","affiliation":[{"name":"SingHealth Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore"},{"name":"Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Singapore Clinical Research Institute, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Wang","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Beijing Children\u2019s Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Caporal","sequence":"additional","affiliation":[{"name":"LARed Network Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan D.","family":"Roa","sequence":"additional","affiliation":[{"name":"Pediatric Neurocritical Care, Fundaci\u00f3n Homi\u2013Universidad del Bosque, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freddy Israel Pantoja","family":"Chamorro","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital Infantil Los \u00c1ngeles, Universidad de Nari\u00f1o, Pasto, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thelma Elvira","family":"Teran Miranda","sequence":"additional","affiliation":[{"name":"Unidad de Terapia Intensiva Pedi\u00e1trica, Hospital del Ni\u00f1o Manuel Ascencio Villarroel, Cochabamba, Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxing","family":"Dang","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Children\u2019s Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin Seng","family":"Gan","sequence":"additional","affiliation":[{"name":"Paediatric Intensive Care Unit, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qalab","family":"Abbas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan J.","family":"Ardila","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care, Cl\u00ednica Uros, Neiva, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohannad Ahmad","family":"Antar","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Medicine, King Abdullah Specialist Children\u2019s Hospital, National Guard Health Affairs, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas A.","family":"Dom\u00ednguez-Rojas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Pediatric Critical Care Medicine, Instituto Nacional de Salud del Ni\u00f1o, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Mi\u00f1ambres","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Pediatrics Department, Virgen de la Arrixaca Hospital, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia Zita","family":"Watzlawik","sequence":"additional","affiliation":[{"name":"Hospital de Pediatr\u00eda Juan P. 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