High Dose Mannitol

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I read the correspondence on http://www.crash2.lshtm.ac.uk/Mannitol.htm .Its
a little hard to understand what happened, do you have any further details
about the concerns of fabrication?
rangraj
On 1/4/07, Coats Tim - Professor of Emergency Medicine <
Tim.Coats at uhl-tr.nhs.uk> wrote:
>
> Dear all,
>
> Prof Ian Roberts, who chairs the Cochrane Injuries Group, has asked me
> to pass on the information below, which has led to the withdrawal of the
> Cochrane review on high dose mannitol. Details are available on the
> CRASH2 website.
> My interpretation is that this is a sad story and that we will probably
> never know the truth. However it does seem that the data in the three
> published papers cannot be verified, greatly reducing the body of
> evidence for high dose mannitol therapy.
>
> Tim. Coats.
> Professor of Emergency Medicine.
> Leicester University
>
> Dear Tim
> The Cochrane Injuries Group conducted an investigation into some head
> injury trials by Cruz et al - the details should be of interest to the
> trauma community.
> We have put the key correspondence on the trial website to make it
> available to our collaborators but I wondered if you could let the folk
> at trauma.org know about it as well.
> Between 2001 and 2004, three reports were published by Dr Julio Cruz and
> colleagues presenting the results of three clinical trials comparing
> high dose and conventional dose mannitol in the treatment of head
> injury. They appeared to show that high dose mannitol was dramatically
> effective in reducing death and disability after head injury.
> Cruz C, Minoja G, Okuchi K. Improving clinical outcomes from acute
> subdural hematomas with emergency preoperative administration of high
> doses of mannitol: a randomized trial. Neurosurgery 2001;49(4):864-71.
> Cruz C, Minoja G, Okuchi K. Major clinical and physiological benefits of
> early high doses of mannitol for intraparenchymal temporal lobe
> hemorrhages with abnormal pupilary widening. Neurosurgery
> 2002;51(3):628-38.
> Cruz J, Minoja G, Okuchi K, Facco E. Successful use of the new high-dose
> mannitol treatment in patients with Glasgow Coma Scores of 3 and
> bilateral abnormal pupillary widening: a randomized trial. Journal of
> Neurosurgery 2004;100(3):376-83.
> The trials were included in a systematic review of the effectiveness of
> mannitol in head injury and published in the Cochrane Library in July
> 2005. The review concluded that "high dose mannitol appears to be
> preferable to conventional dose mannitol in the acute management of
> comatose patients with severe head injury."
> The Cochrane Injuries Group later discovered that there were concerns
> about these trials and an investigation was made the results of which
> are available on the CRASH-2 website (www.crash2.lshtm.ac.uk
> </exchweb/bin/redir.asp?URL=http://www.crash2.lshtm.ac.uk> ). We know
> that mannitol is widely used in the management of patients with head
> trauma and felt that you should be made aware of the Injuries Group
> investigation as soon as possible. Please pass this message on to your
> colleagues in trauma care.
> Ian
>
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