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About SickKids

June 4, 2008

New research warrants caution when applying common therapy to children with severe, traumatic brain injury

( Toronto ) – An international team of researchers from 17 centres led by a scientist at The Hospital for Sick Children (SickKids) has discovered that the common practice of cooling paediatric patients after traumatic brain injury does not improve the neurological outcome of patients and may actually increase mortality. Their research is reported in the June issue of The New England Journal of Medicine .

Many paediatric centres currently use hypothermia therapy to treat patients with severe traumatic brain injury. Cooling is used to help prevent swelling of the brain and a build up of intracranial pressure, which can prohibit oxygen from reaching the brain and exacerbate the injury.

The randomized controlled trial is the largest study of its kind ever published and the first collaborative study of children with head injury among international paediatric intensive care units. It involved 225 children in 17 centres in Canada , France and the United Kingdom . Children with severe traumatic brain injury were assigned to either hypothermia therapy (32.5°C for 24 hours) initiated within eight hours after injury, or to normothermia (37.0°C), normal body temperature, and were followed for up to 12 months after the therapy. At the six-month assessment, 32 of 102 patients (31%) in the hypothermia group compared to 23 of 103 (22%) in the normothermia group exhibited a severe disability, persistent vegetative state or died. There were 23 deaths in the hypothermia group and 14 deaths in the normothermia group.

“We were very surprised by these findings, since preliminary research in adults with traumatic brain injury had demonstrated the potential benefit of hypothermia therapy,” says the lead author of the study, Dr. Jamie Hutchison, staff physician and Director of Research, Department of Critical Care Medicine at SickKids. “While death rates in both groups were not statistically different, the slightly higher mortality in the hypothermia group represents a worrisome trend, which is why we advise that hypothermia therapy only be used under special circumstances.”

Hutchison and his team suspect that hypothermia therapy might be more effective if started earlier and if the patients are cooled for longer durations, followed by a slower re-warming period. The study also proved that hypothermia therapy is effective in lowering intracranial pressure in patients exhibiting elevated levels, which Hutchison calls an exciting discovery.

Given that traumatic brain injury is the most common cause of death and acquired handicap in children, as reported by the National Centre for Health Statistics, the discoveries are critical to efforts to inform clinical care and improve patient outcomes. Moving forward, Hutchison is working toward creating a therapy that could mimic the effects of cooling but that could be administered on the scene by a paramedic so that a patient would benefit immediately from its protective effects, greatly increasing the chance of preventing swelling and further damage to the brain until such time as an effective hypothermia therapy could begin.

The study was supported by the Canadian Institutes of Health Research (Canadian Neurotrauma Research Program), the Ontario Neurotrauma Foundation, the Rick Hansen Foundation, the SickKids Foundation, the Physicians Services Incorporated, Fonds de la Recherche en Santé du Quebec, and the Children's Hospital of Eastern Ontario Research Institute. The trial was conducted by the Canadian Critical Care Trials Group, an association of over 100 practitioners and trainees in 30 critical care research programs that enhance understanding of how complex disease processes can be safely modified or cured, with an aim to improve patient outcomes.

The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, is Canada's most research-intensive hospital and the largest centre dedicated to improving children's health in the country. As innovators in child health, SickKids improves the health of children by integrating care, research and teaching. Our mission is to provide the best in complex and specialized care by creating scientific and clinical advancements, sharing our knowledge and expertise and championing the development of an accessible, comprehensive and sustainable child health system. For more information, please visit http://www.sickkids.ca/ . SickKids is committed to healthier children for a better world.

For more information, please contact:

Janice Nicholson
Public Affairs
The Hospital for Sick Children
Phone: 416-813-6684
Fax: 416-813-5328
email: janice.nicholson@sickkids.ca