Traumatic brain injury

Abstract

Maintaining physiological targets in several areas remains part of protocol led care in the acute phase of TBI management. As evidence accumulates however, the target values and therefore therapies may be set to change.

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

“…Studies that specifically analyse scores to predict the risk of deterioration in TBI are scarce. The scales most studied are the Revised Trauma Score [36], the GCS [16,18] and different physiological and analytical parameters [37] or scores on spinal damage [38]. Najafi et al [39] analyzed the use of different scores to predict the risk of death within 24 hours, including the NEWS, offering our study (although with a mortality outcome within 48 hours) better AUROC, as well as better sensitivity and specificity.…”

Managing Traumatic Brain Injury: Translating Military Guidelines to the Wilderness

“…If monitoring is unavailable, the patient's level of consciousness, mental status, pupil size, motor response, pulse, and respiration should be the minimum observed and recorded to assess for changes in the patient's status. [21][22][23]28,42,43 Although it is impossible to predict which mild TBIs will progress and thus which patients will need to be evacuated, all patients with moderate or severe TBI should be evacuated as soon as possible. Maintaining vital signs and normal temperature and minimizing additional trauma is crucial.…”

“…Maintaining a normal ICP, a normal MAP, and a CPP >60 mm Hg 18,19 is associated with improved outcomes. 18 ,21,23,41…”

“…The field methods for treating increased intracranial pressure and herniation are temporary measures, and rapid evacuation to a medical facility with neurosurgical capability is critical (algorithm summarized in Figure 1). 16 ,21–23,43,47…”

“…[16][17][18][19][20][21][22] While prehospital TBI management is really no different in the military and civilian arenas, other than medication use (ketamine and hypertonic saline) perhaps, the military's emphasis on immediate evacuation, early and aggressive decompression, and invasive monitoring during early postoperative care has been demonstrated to lead to improved outcomes in penetrating brain injuries. 23,24 Definition TBI has been broadly classified as either mild, moderate, or severe. Part of this definition is based on the 15-point, modified Glasgow Coma Score (GCS), which has been used to assess neurologic condition after a head injury (Table ).…”