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A previous saline versus albumin fluid evaluation (SAFE) randomised trial of people admitted to intensive care for various conditions found no difference in survival at 28 days between patients randomised to fluid resuscitation with saline and those randomised to 4% albumin. However, a subgroup analysis of people with severe traumatic brain injury indicated that saline might be better than albumin for this subgroup of patientspatients.
A post hoc 24 month follow-up of the original SAFE trial included 460 people with traumatic brain injury. It confirmed that saline seems to be better than albumin for fluid resuscitation in those with severe injury (a score of 8 or less on the Glasgow coma scale). In the two years after randomisation, 71 of the 214 (33%) people with traumatic brain injury who received albumin died, compared with 42 of the 206 (20%) who received saline (relative risk 1.63, 95% CI 1.17 to 2.26). The corresponding numbers for the subgroup of people with severe injury were 61 of 144 (42%) and 32 of 146 (22%) (1.88, 1.31 to 2.70), but survival was not significantly different for people with Glasgow coma scores 9-12.