331 A Randomized Controlled Clinical Trial using α-Tocopherol and Ascorbic Acid in the Treatment of Moderate Traumatic Brain Injury

Abstract

INTRODUCTION: Traumatic Brain Injury (TBI) is a major public health concern and a leading cause of disability worldwide. It accounts for 40% of all deaths from acute injuries worldwide. Oxidative brain damage is one of the most validated pathophysiologic hallmark of secondary traumatic brain injury. METHODS: 120 patients admitted to Jos University Teaching Hospital with moderate TBI were included in this study. Patients were randomized into 4 equally sized groups: control, enteral α-Tocopherol, intravenous ascorbic acid, or a combination of the latter treatments. Patients were administered the designated drugs for a period of one week in addition to the standard management of head injuries. The control group received neither of these drugs but just the standard management of head injury. Outcome data were collected prospectively including demographics, head injury characteristics, mortality, length of stay (LoS) and Glasgow outcome score (GOS). RESULTS: 92.5% (n = 111) of patients were male. The most common cause for TBI was road traffic accidents (n = 102). GOS was significantly higher in all treatment groups when compared to the control group at discharge (ascorbic acid p < 0.01, α-Tocopherol p < 0.001, combination p < 0.001), and at 1 and 3 months follow up. Overall mortality was significantly lower in patients treated with either α-Tocopherol (n = 1, 3.3%), ascorbic acid (n = 1, 3.3%) or a combination (n = 0, 0%) compared to the placebo group (n = 8, 26.7%, p < 0.05). The lenght of hospital stay was significantly reduced in the α-Tocopherol (p < 0.05) and the combination groups (p < 0.001) CONCLUSIONS: The use of ascorbic acid and/or α-Tocopherol improved survival in this cohort. A combination of both drugs had a potentially synergistic effect in these patients.