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Adult patients with head trauma should be cooled but not children

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Adult patients with traumatic head injuries should be cooled down to improve their chances of survival, but this could prove fatal if attempted in children, warn UK researchers.

Therapeutic hypothermia involves reducing the body temperature of a person to protect neurons from being killed off or damaged.

“We have undertaken the largest such analysis of data on the use of therapeutic hypothermia”

Pankaj Sharma

Although the technique is commonly-used in intensive care units in the UK, the few previous studies into it have often produced conflicting results.

A study led by Edinburgh University that tracked the outcomes of nearly 400 cases of traumatic brain injury from 18 countries concluded last year that cooling did not improve the chances of recovery.

However, a new and much larger study published in the journal Critical Care Medicine has come out in favour of cooling in adult patients.

It found that lowering the body temperature of patients who have experienced a traumatic brain injury as soon as possible afterwards may significantly improve chances of survival in adults.

The researchers found that adults subjected to medically induced hypothermia were significantly less likely to die or suffer serious cognitive impairment due to damaged neurons.

The team, from Imperial College London, Royal Holloway University, Ashford and St Peters NHS Foundation Trust, assessed around 3,100 brain injury cases in adults and about 450 in children.

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St Peter’s Hospital, Chertsey

They found that cooling the brain to a temperature of 33oC for 72 hours, and then allowing the patient to return to their normal temperature of 37oC at their natural speed was most effective.

Study author Professor Pankaj Sharma, from Royal Holloway, said: “Lowering the body temperature to treat people with traumatic brain injury is a controversial treatment, but one that our latest research has shown to reduce deaths and long-term injury.

“We have undertaken the largest such analysis of data on the use of therapeutic hypothermia and have found that patients have an 18% better chance of surviving and a 35% improvement in neurological outcome if they are given this treatment,” he said.

But he added: “While cooling adults is effective at providing the best possible outcome, cooling children instead can prove fatal. In children between the ages of three months and 18 years, cooling provoked a 66% increase in mortality.

“This research has far-reaching implications in medicine, potentially affecting the treatment of millions of patients world-wide,” he said.

The authors noted that the World Health Organization has predicted that traumatic brain injury will become a major cause of death and disability across the world. Though it can be caused by many things, including car accidents, most are caused by falls.

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