Hypertonic Saline for Prehospital Treatment of Traumatic Brain Injury

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.