• Elyse Berger Pelletier, Marcel Émond, François Lauzier, Martin Savard, and Alexis F Turgeon.
• Research Center of the Centre Hospitalier Universitaire (CHU) de Québec, Axe Santé des populations et pratiques optimales en santé (Population Health and Optimal health practices Research Unit), Traumatologie - Urgence - Soins Intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada; Department of Family and Emergency Medicine, Université Laval, Québec City, Québec, Canada.
• Plos One. 2014 Jan 1;9(4):e95778.

IntroductionWorldwide, severe traumatic brain injury is a frequent pathology and is associated with high morbidity and mortality. Mannitol and hypertonic saline are therapeutic options for intracranial hypertension occurring in the acute phase of care. However, current practices of emergency physicians are unknown.MethodsWe conducted a self-administered survey of emergency physicians in the province of Québec, Canada, to understand their attitudes surrounding the use of hyperosmolar solutions in patients with severe traumatic brain injury. Using information from a systematic review of hypertonic saline solutions and experts' opinion, we developed a questionnaire following a systematic approach (items generation and reduction). We tested the questionnaire for face and content validity, and test-retest reliability. Physicians were identified through the department head of each eligible level I and II trauma centers. We administered the survey using a web-based interface and planned email reminders.ResultsWe received 210 questionnaires out of 429 potentials respondents (response rate 49%). Most respondents worked in level II trauma centers (69%). Fifty-three percent (53%) of emergency physicians stated using hypertonic saline to treat severe traumatic brain injury. Most reported using hyperosmolar therapy in the presence of severe traumatic brain injury and unilateral reactive mydriasis, midline shift or cistern compression on brain computed tomography.ConclusionHyperosmolar therapy is believed being broadly used by emergency physicians in Quebec following severe traumatic brain injury. Despite the absence of clinical practice guidelines promoting the use of hypertonic saline, a majority of them said to use these solutions in specific clinical situations.

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