Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Cooper and colleagues1 found no benefit to prehospital administration
of 250 mL of 7.5% hypertonic saline among patients with hypotension and severe
traumatic brain injury. It is not clear, however, whether the trial had sufficient
statistical power to detect a meaningful difference. The trial was designed
to detect a 20% improvement in the conventional extended Glasgow Outcome Score
(GOSE) with 80% power and an α statistical value of .05. I do not think
this is an ideal end point because I believe that most clinicians and patients
would not view a change from death to persistent vegetative state or from
persistent vegetative to severe disability as a treatment success.
Zygun D. Hypertonic Saline for Prehospital Treatment of Traumatic Brain Injury. JAMA. 2004;291(24):2943-2944. doi:10.1001/jama.291.24.2943