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Children's Hospital surgeon to lead trial on head trauma
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A neurosurgeon at Children's Hospital of Pittsburgh will lead a national clinical trial to determine whether the process of cooling children with severe head-trauma injuries for 48 hours reduces or eliminates long-term brain damage.
Dr. P. David Adelson, director of the Pediatric Neurotrauma Center at Children's Hospital, a University of Pittsburgh Medical Center facility, will lead researchers at 12 sites nationwide in a $11.5 million clinical trial funded through the National Institute of Neurological Disorders and Stroke.
During the five-year study, 340 children 16 and under who suffer severe brain trauma injuries will be studied to see if they experience improved outcomes by undergoing hypothermia, or having their bodies cooled to 89 to 90 degrees Fahrenheit for 48 hours (normal body temperature is 98.6 degrees). The key is initiating the hypothermic treatment within six hours of injury.
Patients must have severe closed-head injuries that do not penetrate the skull and must receive hypothermic treatment as quickly as possible. Because cooling patients to such temperatures has been shown to be safe, and need for quick action, doctors will proceed with hypothermic treatment without parental permission. A vast majority of parents consent to the treatment, but it will be discontinued if they object.
For closed-head trauma, where the skull remains intact, there currently are few treatment options. The skull is a closed box, so when the brain is injured, there is little room for swelling, causing blood flow to decrease, leading to brain damage.
Why cooling might work is not yet clear, but it could reduce inflammation, much like putting ice on a swollen ankle. It might also stem other cascading events that cause the brain to swell. Reducing swelling could mean preventing injury.
"Hypothermia affects different aspects regarding swelling and injury," Dr. Adelson said. "We've proven this therapy is safe. Now if we can determine that it is effective, it would be a major breakthrough because currently there are very limited treatments that improve outcome following traumatic brain injury in children."
More details in tomorrow's Pittsburgh Post-Gazette.
First Published May 17, 2007 5:21 pm
