Traumatic brain injury

PETER JD ANDREWS

As widely appreciated, outcome after traumatic brain injury depends upon the initial severity of the injury, age, the extent of any subsequent complications, and how these are managed. Much of the early management of traumatic brain injury falls upon emergency room staff, primary care and ambulance services being involved prior to hospital admission. Of the many patients who attend hospital after a traumatic brain injury, most do not develop life threatening complications in the acute stage. However, in a small but important subgroup, outcome is made worse by failure to detect promptly and deal adequately with complications.

There is of course no debate about the effectiveness of surgical removal of an acute compressive intracranial haematoma, nor the interventions required to correct hypotension or hypoxia. Much of the debate surrounding management of patients with traumatic brain injury is instead focused on methods used to identify the patients at risk and provision of appropriate care, including utilisation of investigations, clinical observations required, and determination of the most appropriate site(s) of such care.

There has clearly been an improvement in the outcome of patients who have sustained a traumatic brain injury (TBI) in recent years. None the less, many clinicians still believe that there has been little real progress in this area. It should be emphasised that mortality after severe (coma inducing) TBI has fallen from around 50% to 25% over the past 20 years. Further those who survive are less likely to remain severely disabled than in the past.

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