Management of Traumatic Brain Injury

Initial Assessment and Severity Classification

The American College of Surgeons recommends assessing TBI severity using the Glasgow Coma Scale (GCS), with particular attention to the motor response component, along with pupillary size and reactivity, as these are key predictors of neurological outcomes 1, 2
The motor component of GCS remains robust even in sedated patients and correlates well with head trauma severity 1
Repeated neurological examinations should be performed to detect secondary neurological deterioration, with frequency determined by severity 1, 2
For moderate TBI (GCS 9-13), neurological examinations should be conducted frequently as these patients have significant risk of secondary deterioration 1

The European Society of Anaesthesiology recommends managing severe TBI patients with a pre-hospital medicalized team and transferring them as quickly as possible to specialized centers with neurosurgical facilities 3, 4
Systolic blood pressure should be maintained >110 mmHg prior to measuring cerebral perfusion pressure to prevent secondary injury 4
Brain and cervical CT scan should be performed without delay in severe TBI patients to diagnose primary brain lesions and guide neurosurgical procedures 3, 4
Early CT-angiography of supra-aortic and intracranial arteries should be considered in patients with risk factors for vascular injury 4

For multiple trauma with TBI, management of life-threatening injuries should be prioritized while avoiding secondary brain injury 4
For pediatric TBI patients, age-specific physiological parameters and management approaches should be considered 2

Hypotension (systolic BP <110 mmHg) should be avoided as it significantly worsens outcomes in TBI patients 4
Biomarkers should not be used in clinical routine for initial TBI severity assessment as their utility remains uncertain 3
Hyperoxia after stabilization should be avoided as it may worsen outcomes 5