(1561) Evaluation of 23.4% Hypertonic Saline Versus 3% Hypertonic Saline in Intracranial Hemorrhage

Introduction: Hypertonic saline is regarded as an effective therapy for the management of elevated intracranial pressure (ICP) in traumatic intracranial hemorrhage (ICH). Recent studies demonstrate hypertonic saline solutions are associated with reduced ICH burden and improved 90-day mortality. However, data defining the ideal concentration of hypertonic saline is limited. The purpose of this study is to compare the effects of 23.4% plus 3% hypertonic saline versus 3% hypertonic saline for prevention of hematoma expansion in traumatic ICH.

Methods: In this single center, retrospective cohort study all adult patients admitted for traumatic ICH between January 1, 2018 to December 31, 2021 receiving at least one dose of either 23.4% or 3% hypertonic saline were included. The primary outcome was hematoma expansion on repeat imaging. Secondary outcomes include in-hospital mortality at 7 days, intensive care unit (ICU) length of stay, length of hospital stay, time to serum sodium of 145 to 160 mEq/L, time to serum osmolality of 300 to 320 mOsm/kg, incidence of hypernatremia, incidence of acute kidney injury, and need for surgical intervention.

Results: 77 patients were included, with 57 patients in the 3% hypertonic saline group and 20 patients in the 23.4% plus 3% hypertonic saline group. Assessment of baseline characteristics revealed a statistically significant disparity between the two groups regarding initial Glasgow coma scale (p=0.034). Primary and secondary outcomes were adjusted for initial Glasgow coma scale using a multivariable logistic regression. Length of ICU stay was 11.9 days in the 3% hypertonic saline group and 13.1 days in the 23.4% plus 3% hypertonic saline group (p=0.65). Hematoma expansion on repeat imaging was seen in 49.1% of patients in the 3% hypertonic saline group and 35% of patients in the 23.4% plus 3% hypertonic saline group (aOR 0.8; 95% CI, 0.62 to 1.03; p=0.08). Time to event outcome analysis found no statistically significant difference in the hazard of hematoma expansion between the two groups. (aHR: 1.21, 95% CI, 0.71 to 2.06, p=0.48).

Conclusions: While the results of this study were not statistically significant, the secondary outcome analysis showed no increased risk in adverse effects in the 23.4% plus 3% hypertonic saline group.