Out-of-hospital administration of hypertonic fluids following severe traumatic brain injury (TBI) offers no additional benefits over normal saline in patients who are not in hypovolemic shock, according to a report in the October 6 JAMA. In a double-blind, randomized, placebo-controlled multi-center trial of patients 15 and older with blunt trauma and a prehospital Glasgow Coma Scale score of 8 or less, subjects received a single 250-mL bolus of either hypertonic saline with dextran (7.5% saline/6% dextran 70), hypertonic saline (7.5% saline), or normal saline (0.9% saline). Six-month data, which were available for 1,087 of the 1,282 patients enrolled in the study, showed no difference in neurologic outcome and no significant differences in disability by treatment group. Survival rates at 28 days were 74.3% in the hypertonic/dextran group, 75.7% in the hypertonic group, and 75.1% with normal saline.