• Clinical science
  • Clinician

Traumatic brain injury


Traumatic brain injury (TBI), also referred to as head injury, is acute physical damage to the brain caused by an external impact. TBI is most frequently seen in young children, teenagers, and individuals above the age of 65. Motor vehicle accidents are the most common cause. Although the skull is often fractured in the process, acute cerebral damage can occur even if the skull remains intact. Clinical findings depend on the severity, type, and location of injury. Impaired consciousness is common in more severe TBI, whereas patients with mild TBI often only experience transient confusion, headaches, or nausea. Elevated intracranial pressure, hemorrhages, and seizures may occur rapidly after injury in severe cases, or develop as complications over the course of the illness. Skull fractures may cause immediate damage to sensory organs or cranial nerves, while also increasing the risk of infection. A noncontrast head CT is the diagnostic method of choice for detecting common pathologies such as fractures, midline shifts, or hemorrhages. Treatment is usually not required for mild TBI, although patients should be monitored for 24 hours to rule out complications. In most cases of more severe TBI, specific medical (e.g., reduction of intracranial pressure, prevention of seizures or infections) or surgical (e.g., decompressive craniectomy) measures are necessary.


  • Acute physical damage to the brain as a result of an external force



  • Incidence: ∼ 800/100,000
  • Age: especially children 0–4 years, teenagers and young adults 15–24 years, and adults > 65 years
  • Sex: >


Epidemiological data refers to the US, unless otherwise specified.


  1. Falls
  2. Motor vehicle accidents
  3. Contact sports (e.g., football)
  4. Gunshot wounds



Primary and secondary injury

  • Primary injury: acute physical injury that is dealt to the brain during the traumatic event
    • Acceleration-deceleration trauma
      • Coup injury: cerebral contusion on the side of an impact
      • Contrecoup: additional cerebral contusion on the opposite side of impact
    • Contact trauma: may involve fractures of the skull or superficial wounds (focal injury)
  • Secondary injury: pathologic changes induced by inadequate cerebral perfusion and/or inflammatory processes after primary injury

Consequences of injury


Clinical features

Clinical findings vary depending on the location, severity, and type of injury. In addition to the initial presentation, further symptoms may develop as lesions progress (e.g., intracranial hemorrhages).

General symptoms

Signs of basilar skull fracture

Possible traumatic brain injury must always be considered in a patient with a reduced level of consciousness (unless another cause is evident)!

Skull fractures, (worsening) neurological impairment, repeated vomiting, and seizures are indicative of more severe trauma or intracranial hemorrhage



General approach to TBI patients

Acute stabilization and measures of life support should always take precedence over diagnostic investigations!

  • Cranial CT (without contrast) if consciousness is impaired
  • Glasgow Coma Scale (GCS) for evaluation of consciousness
    • Assessment of neurological status and trauma severity in patients with traumatic brain injury (mostly used in acute cases)
    • Maximum score 15 points (full consciousness); minimum score 3 points (coma or death)
Points Eye opening Verbal response Motor response
6 Obeys commands
5 Appropriate words and oriented Localizes pain stimulus
4 Spontaneously Appropriate words but confused Withdraws from pain
3 To verbal command Inappropriate words Decorticate posture
2 To pain Incomprehensible sounds Decerebrate posture
1 No response No response No response
Mild head injury: GCS score 13–15 Moderate head injury: GCS score 9–12 Severe head injury: GCS score ≤ 8 (Indication for endotracheal intubation)
  • Additional investigations: exact description of injury mechanism with evaluation of injuries; full medical and neurological examination




Mild TBI

  • No specific treatment
  • Monitoring for 24 h
  • Temporary rest and symptomatic pharmacotherapy
  • For athletes: Refrain from contact sports for a week, re-evaluate at that time
    • Observe for 6 hours in the ED for worsening
    • Following discharge → six stages of gradual recovery, each stage requiring at least 24 hours
      1. No activity
      2. Light aerobic exercise
      3. Sport-specific exercise
      4. Non-contact workouts
      5. Full-contact practice
      6. Return to full play

Acute management checklist for concussion [21]

  • Cognitive rest for 24–48 hours
  • Physical rest for 24–48 hours
  • Supportive care
  • Avoid any medications that can mask the symptoms of concussion (e.g., sedatives). [23]
  • Consider imaging (head CT without contrast) in the following patient groups: [24]
    • Loss of consciousness or post-traumatic amnesia
    • Persistently decreased mental status (GCS < 15)
    • Presence of any focal neurologic deficits
    • Signs of skull fracture on examination
    • Clinical deterioration

More severe TBI




We list the most important complications. The selection is not exhaustive.


  • Mild TBI: usually self-limiting
  • Severe TBI: mortality rate as high as 30%


Special patient groups

When evaluating children and infants with TBI, a number of special issues must be observed.

  • Causes:
    • Falls (most common)
    • The possibility of child abuse must always be considered.
  • Clinical features: : esp. bulging anterior fontanelle (↑ ICP)
  • Diagnosis: cranial CT without contrast
    • Identify patients with significant TBI but avoid unnecessary radiographic testing
    • CT recommended for signs of skull fractures, ↑ ICP, major neurologic symptoms (e.g., impaired consciousness, seizures), suspected child abuse
    • Consider CT: if less severe symptoms (e.g., changes in behavior, self-limited vomiting) are present.
  • Management
    • Inpatient observation indications
      • Skull fracture > 3 mm separation or depressed
      • Evidence of traumatic brain injury on imaging (e.g.., intracranial hemorrhage)
      • Signs of ↑ ICP (e.g., headache, altered mental status)
      • Suspected physical abuse
      • Caregivers who are unreliable or unable to return if neurological deficits develop within 24 hours after release.
    • Release and at-home observation for 24 hours
      • Patients without neurological deficits and non-depressed linear skull fracture < 3 mm separation
      • Requires a caregiver who can reliably recognize new clinical neurological deficits and return the patient to the hospital if such manifestations arise


  • 1. Dawodu ST. Traumatic Brain Injury (TBI): Definition and Pathophysiology. In: Traumatic Brain Injury (TBI): Definition and Pathophysiology. New York, NY: WebMD. http://emedicine.medscape.com/article/326510. Updated September 22, 2015. Accessed February 23, 2017.
  • 2. Hemphill JC III. Traumatic brain injury: Epidemiology, classification, and pathophysiology. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/traumatic-brain-injury-epidemiology-classification-and-pathophysiology. Last updated November 8, 2016. Accessed February 23, 2017.
  • 3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention . Report to Congress: Traumatic Brain Injury In the United States: Epidemiology and Rehabilitation. url: https://www.cdc.gov/traumaticbraininjury/pdf/tbi_report_to_congress_epi_and_rehab-a.pdf Accessed February 23, 2017.
  • 4. Bernhardt DT. Concussion. In: Concussion. New York, NY: WebMD. http://emedicine.medscape.com/article/92095-overview. Updated July 25, 2016. Accessed February 23, 2017.
  • 5. Le T, Bhushan V, Bagga HS. First Aid for the USMLE Step 2 CK. McGraw-Hill Medical; 2009.
  • 6. Morales DL. Brain Contusion Imaging. In: Brain Contusion Imaging. New York, NY: WebMD. http://emedicine.medscape.com/article/337782-overview. Updated November 1, 2015. Accessed February 23, 2017.
  • 7. Pangilinan PH. Classification and Complications of Traumatic Brain Injury. In: Classification and Complications of Traumatic Brain Injury. New York, NY: WebMD. http://emedicine.medscape.com/article/326643. Updated February 13, 2017. Accessed February 23, 2017.
  • 8. Evans RW. Postconcussion syndrome. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/postconcussion-syndrome. Last updated October 10, 2013. Accessed February 24, 2017.
  • 9. Evans RW, Whitlow CT. Acute Mild Traumatic Brain Injury (Concussion) in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/acute-mild-traumatic-brain-injury-concussion-in-adults. Last updated April 29, 2015. Accessed March 16, 2018.
  • 10. Watanabe K, Kida W. Images in clinical medicine: Battle's sign. N Engl J Med. 2012; 367(12): p. 1135. doi: 10.1056/NEJMicm1100820.
  • 11. Heegaard WG, Biros MH. Skull Fractures in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/skull-fractures-in-adults. Last updated July 26, 2017. Accessed November 18, 2017.
  • 12. Qureshi NH. Skull Fracture. In: Kopell BH. Skull Fracture. New York, NY: WebMD. https://emedicine.medscape.com/article/248108. Updated July 18, 2017. Accessed November 18, 2017.
  • 13. Turel KE. Post traumatic facial paralysis treatment options and strategies. Indian Journal of Neurotrauma. 2005. url: http://medind.nic.in/icf/t05/i1/icft05i1p33.pdf.
  • 14. Ernst A, Herzog M, Seidl RO. Head and Neck Trauma. Stuttgart, Germany: Georg Thieme Verlag; 2006.
  • 15. Agabegi SS, Agabegi ED. Step-Up To Medicine. Baltimore, MD, USA: Wolters Kluwer Health; 2015.
  • 16. Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education; 2015.
  • 17. Fischer C. Master the Boards USMLE Step 2 CK. New York, NY: Kaplan Publishing; 2013.
  • 18. Hemphill JC III, Phan N. Management of acute severe traumatic brain injury. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/management-of-acute-severe-traumatic-brain-injury. Last updated February 10, 2015. Accessed February 24, 2017.
  • 19. Kantor D. Decerebrate posture. https://medlineplus.gov/ency/article/003299.htm. Updated June 1, 2015. Accessed February 24, 2017.
  • 20. Knipe H, Barras C, et al. CT angiographic spot sign. https://radiopaedia.org/articles/ct-angiographic-spot-sign-1. Updated February 24, 2017. Accessed February 24, 2017.
  • 21. Reams N, Bodnya J. Concussion management. Disease-a-Month. 2019; 65(10): p. 100853. doi: 10.1016/j.disamonth.2019.02.006.
  • 22. American Association of Neurological Surgeons. Concussion. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Concussion. Accessed November 15, 2019.
  • 23. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013; 47(5): pp. 250–258. doi: 10.1136/bjsports-2013-092313.
  • 24. Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013; 80(24): pp. 2250–2257. doi: 10.1212/wnl.0b013e31828d57dd.
  • 25. Haydel M. Management of mild traumatic brain injury in the emergency department. Emergency medicine practice. 2012; 14(9): pp. 1–24. pmid: 23101569.
  • 26. Evans RW. Sequelae of Mild Traumatic Brain Injury. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/sequelae-of-mild-traumatic-brain-injury. Last updated November 7, 2017. Accessed March 16, 2018.
  • 27. Schutzman S. Minor head trauma in infants and children: Evaluation. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/minor-head-trauma-in-infants-and-children-evaluation. Last updated July 20, 2016. Accessed February 24, 2017.
  • 28. Eiff MP, Hatch RL. Fracture Management for Primary Care Updated Edition E-Book. Elsevier Health Sciences; 2017.
  • Yang Y, Zheng F, Xu X, Wang X. Levetiracetam Versus Phenytoin for Seizure Prophylaxis Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis. CNS Drugs. 2016; 30(8): pp. 677–88. doi: 10.1007/s40263-016-0365-0.
  • Spencer MP. Ultrasonic Diagnosis of Cerebrovascular Disease. Springer Science & Business Media; 2012.
  • Madan A. Correlation between the levels of SpO2and PaO2. Lung India. 2017; 34(3): pp. 307–308. doi: 10.4103/lungindia.lungindia_106_17.
  • Robertson CS, Hannay HJ, Yamal J-M, et al. Effect of Erythropoietin and Transfusion Threshold on Neurological Recovery After Traumatic Brain Injury. JAMA. 2014; 312(1): p. 36. doi: 10.1001/jama.2014.6490.
  • Zhu C, Chen J, Pan J, Qiu Z, Xu T. Therapeutic effect of intensive glycemic control therapy in patients with traumatic brain injury. Medicine. 2018; 97(30): p. e11671. doi: 10.1097/md.0000000000011671.
  • Klingbeil KD, Koch S, Dave KR. Potential link between post-acute ischemic stroke exposure to hypoglycemia and hemorrhagic transformation. Int J Stroke. 2017: p. 174749301774379. doi: 10.1177/1747493017743797.
  • Lewis SR, Evans DJ, Butler AR, Schofield-Robinson OJ, Alderson P. Hypothermia for traumatic brain injury. Cochrane Database Syst Rev. 2017. doi: 10.1002/14651858.cd001048.pub5.
  • Wada R, Aviv RI, Fox AJ, et al. CT Angiography “Spot Sign” Predicts Hematoma Expansion in Acute Intracerebral Hemorrhage. Stroke. 2007; 38(4): pp. 1257–1262. doi: 10.1161/01.str.0000259633.59404.f3.
  • Elisha S, Nagelhout JJ, Heiner JS. Current Anesthesia Practice - E-Book. Elsevier Health Sciences; 2019.
  • Yerram S, Katyal N, Premkumar K, Nattanmai P, Newey CR. Seizure prophylaxis in the neuroscience intensive care unit. Journal of Intensive Care. 2018; 6(1): p. 17. doi: 10.1186/s40560-018-0288-6.
  • Tahir R, Pabaney A. Therapeutic hypothermia and ischemic stroke: A literature review. Surg Neurol Int. 2016; 7(15): p. 381. doi: 10.4103/2152-7806.183492.
  • Abend NS, MD NS, Helfaer MA, MD MA. Pediatric Neurocritical Care. Demos Medical Publishing; 2012.
  • Bakr A, Belli A. A systematic review of levetiracetam versus phenytoin in the prevention of late post-traumatic seizures and survey of UK neurosurgical prescribing practice of antiepileptic medication in acute traumatic brain injury. Br J Neurosurg. 2018; 32(3): pp. 237–244. doi: 10.1080/02688697.2018.1464118.
  • Xu JC, Shen J, Shao WZ, et al. The safety and efficacy of levetiracetam versus phenytoin for seizure prophylaxis after traumatic brain injury: A systematic review and meta-analysis. Brain injury. 2016; 30(9): pp. 1054–61. doi: 10.3109/02699052.2016.1170882.
  • Nentwich LM, Jr BGM, Kahn JH. Acute Ischemic Stroke, An Issue of Emergency Medicine Clinics - E-Book. Elsevier Health Sciences; 2012.
  • Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet (London, England). 1974; 2(7872): pp. 81–4. doi: 10.1016/s0140-6736(74)91639-0.
  • Besmertis, L; Bonovich, DC; and Hemphill, JC. The Role of Hypotension in Secondary Brain Injury after Intracerebral Hemorrhage. Stroke. 2001; Vol 32, Issue suppl_1: p. 358. url: https://www.ahajournals.org/doi/10.1161/str.32.suppl_1.358-d.
  • Lin DJ, Lam FC, Siracuse JJ, Thomas A, Kasper EM. "Time is brain" the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide. Surgical Neurology International. 2012; 3(1): p. 98. doi: 10.4103/2152-7806.100187.
  • Rincon S, Gupta R, Ptak T. Imaging of head trauma. Elsevier; 2016: pp. 447–477.
  • V. Schapira AH. Neurology and Clinical Neuroscience E-Book. Elsevier Health Sciences; 2006.
  • Kinoshita K. Traumatic brain injury: pathophysiology for neurocritical care. Journal of Intensive Care. 2016; 4(1). doi: 10.1186/s40560-016-0138-3.
  • AAOS),. Advanced Assessment and Treatment of Trauma. Jones & Bartlett Learning; 2009.
  • Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. The Lancet. Neurology. 2014; 13(8): pp. 844–54. doi: 10.1016/S1474-4422(14)70120-6.
  • Hoffer ME, Balaban C. Neurosensory Disorders in Mild Traumatic Brain Injury. Academic Press; 2019.
  • Perel P, Yanagawa T, Bunn F, Roberts IG, Wentz R. Nutritional support for head-injured patients. Cochrane Database Syst Rev. 2006. doi: 10.1002/14651858.cd001530.pub2.
  • Appleton JP, Sprigg N, Bath PM. Blood pressure management in acute stroke. BMJ. 2016; 1(2): pp. 72–82. doi: 10.1136/svn-2016-000020.
  • Wirth R, Smoliner C, et al. Guideline clinical nutrition in patients with stroke. Exp Transl Stroke Med. 2013; 5(1). doi: 10.1186/2040-7378-5-14.
  • Frankenfield DC, Ashcraft CM. Description and prediction of resting metabolic rate after stroke and traumatic brain injury. Nutrition. 2012; 28(9): pp. 906–911. doi: 10.1016/j.nut.2011.12.008.
  • Fisher M. Stroke. Amsterdam: Elsevier Health Sciences; 2009.
  • Pin-on P, Saringkarinkul A, Punjasawadwong Y, Kacha S, Wilairat D. Serum electrolyte imbalance and prognostic factors of postoperative death in adult traumatic brain injury patients. Medicine. 2018; 97(45): p. e13081. doi: 10.1097/md.0000000000013081.
  • El-Fawal BM, Badry R, Abbas WA, Ibrahim AK. Stress hyperglycemia and electrolytes disturbance in patients with acute cerebrovascular stroke. Egypt J Neurol Psychiatry Neurosurg. 2019; 55(1). doi: 10.1186/s41983-019-0137-0.
  • Moore AJ, Newell DW. Tumor Neurosurgery. Springer Science & Business Media; 2010.
  • Mistri AK, Robinson TG, Potter JF. Pressor Therapy in Acute Ischemic Stroke. Stroke. 2006; 37(6): pp. 1565–1571. doi: 10.1161/01.str.0000222002.57530.05.
  • Hébert PC, Wells G, Blajchman MA, et al. A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care. N Engl J Med. 1999; 340(6): pp. 409–417. doi: 10.1056/nejm199902113400601.
  • Nyquist P, Bautista C, Jichici D, et al. Prophylaxis of Venous Thrombosis in Neurocritical Care Patients: An Evidence-Based Guideline: A Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2015; 24(1): pp. 47–60. doi: 10.1007/s12028-015-0221-y.
  • Lee B, Newberg A. Neuroimaging in traumatic brain imaging. NeuroRx. 2005; 2(2): pp. 372–83. doi: 10.1602/neurorx.2.2.372.
  • Wilberger JE, Mao G. Sports-Related Concussion. https://www.merckmanuals.com/professional/injuries-poisoning/traumatic-brain-injury-tbi/sports-related-concussion. Updated November 1, 2017. Accessed November 15, 2019.
  • McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS ONE. 2017; 12(4): p. e0174847. doi: 10.1371/journal.pone.0174847.
  • American College of Surgeons and the Committee on Trauma. ATLS Advanced Trauma Life Support. Chicago: American College of Surgeons; 2018.
  • Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil. 1993; 8(3): pp. 86–87. url: https://acrm.org/wp-content/uploads/pdf/TBIDef_English_10-10.pdf.
  • Saatman KE, Duhaime A-C, Bullock R, Maas AIR, Valadka A, Manley GT. Classification of Traumatic Brain Injury for Targeted Therapies. J Neurotrauma. 2008; 25(7): pp. 719–738. doi: 10.1089/neu.2008.0586.
  • Menon DK, Schwab K, Wright DW, Maas AI. Position Statement: Definition of Traumatic Brain Injury. Arch Phys Med Rehabil. 2010; 91(11): pp. 1637–1640. doi: 10.1016/j.apmr.2010.05.017.
  • Fomchenko EI, Gilmore EJ, Matouk CC, Gerrard JL, Sheth KN. Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas. Curr Treat Options Neurol. 2018; 20(8). doi: 10.1007/s11940-018-0517-2.
  • Frontera JA, Lewin III JJ, Rabinstein AA, et al. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage. Neurocrit Care. 2015; 24(1): pp. 6–46. doi: 10.1007/s12028-015-0222-x.
  • Bullock MR, Chesnut R, Ghajar J, et al. Guidelines for the Surgical Management of Traumatic Brain Injury Author Group. Neurosurgery. 2006; 58(3): pp. S2–vi–S2–vi. doi: 10.1093/neurosurgery/58.3.vi.
  • Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018; 49(3). doi: 10.1161/str.0000000000000158.
  • Walls R, Hockberger R, Gausche-Hill M. Rosen's Emergency Medicine. Philadelphia, PA: Elsevier Health Sciences; 2018.
  • Walls R, Hockberger R, Gausche-Hill M. Rosen's Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences; 2013.
  • Hemphill JC, Greenberg SM, Anderson CS et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke. 2015; 46(7). doi: 10.1161/STR.0000000000000069.
  • EC J, JL S, Jr AH, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2013; 44(3): pp. 870–947. doi: 10.1161/STR.0b013e318284056a.
  • Kaufman RM, Djulbegovic B, Gernsheimer T. Platelet Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med. 2015; 162(3): pp. 205–213. doi: 10.7326/M14-1589.
  • Carney N, Totten AM, O’Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2016; 80(1): pp. 6–15. doi: 10.1227/neu.0000000000001432.
  • Stolla M, Zhang F, Meyer MR, Zhang J, Dong J. Current state of transfusion in traumatic brain injury and associated coagulopathy. Transfusion (Paris). 2019; 59(S2): pp. 1522–1528. doi: 10.1111/trf.15169.
  • Aarabi B, Alden TD, Chesnut R, Downs J, Ecklund J, Eisenberg H. Guidelines for the management of penetrating brain injury. J Trauma. 2001; 51(2 Suppl): pp. S34–40. pmid: 11505198.
  • Winn HR. Youmans and Winn Neurological Surgery. Philadelphia, PA: Elsevier; 2016.
  • Rosenfeld JV, Bell RS, Armonda R. Current Concepts in Penetrating and Blast Injury to the Central Nervous System. World J Surg. 2014; 39(6): pp. 1352–1362. doi: 10.1007/s00268-014-2874-7.
  • Harmon LA, Haase DJ, Kufera JA, et al. Infection after penetrating brain injury. Journal of Trauma and Acute Care Surgery. 2019; 87(1): pp. 61–67. doi: 10.1097/ta.0000000000002327.
  • Lolli V, Pezzullo M, Delpierre I, Sadeghi N. MDCT imaging of traumatic brain injury. Br J Radiol. 2016; 89(1061): p. 20150849. doi: 10.1259/bjr.20150849.
  • Franz RW, Willette PA, Wood MJ, Wright ML, Hartman JF. A Systematic Review and Meta-Analysis of Diagnostic Screening Criteria for Blunt Cerebrovascular Injuries. J Am Coll Surg. 2012; 214(3): pp. 313–327. doi: 10.1016/j.jamcollsurg.2011.11.012.
  • Bromberg WJ, Collier BC, Diebel LN, et al. Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma. 2010; 68(2): pp. 471–7. doi: 10.1097/TA.0b013e3181cb43da.
  • Brommeland T, Helseth E, Aarhus M, et al. Best practice guidelines for blunt cerebrovascular injury (BCVI). Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2018; 26(1): p. 90. doi: 10.1186/s13049-018-0559-1.
  • Ratilal BO, Costa J, Pappamikail L, Sampaio C. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database of Systematic Reviews. 2015; 4: p. CD004884. doi: 10.1002/14651858.cd004884.pub4.
  • Crompton EM, Lubomirova I, Cotlarciuc I, Han TS, Sharma SD, Sharma P. Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients. Crit Care Med. 2017; 45(4): pp. 575–583. doi: 10.1097/ccm.0000000000002205.
  • Krishnamoorthy V, Chaikittisilpa N, Kiatchai T, Vavilala M. Hypertension After Severe Traumatic Brain Injury. J Neurosurg Anesthesiol. 2017; 29(4): pp. 382–387. doi: 10.1097/ana.0000000000000370.
  • Vella MA, Crandall ML, Patel MB. Acute Management of Traumatic Brain Injury. Surg Clin North Am. 2017; 97(5): pp. 1015–1030. doi: 10.1016/j.suc.2017.06.003.
  • The CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. The Lancet. 2019; 394(10210): pp. 1713–1723. doi: 10.1016/s0140-6736(19)32233-0.
  • Souter MJ, Blissitt PA, Blosser S, et al. Recommendations for the Critical Care Management of Devastating Brain Injury: Prognostication, Psychosocial, and Ethical Management. Neurocrit Care. 2015; 23(1): pp. 4–13. doi: 10.1007/s12028-015-0137-6.
  • Le Roux P, Menon DK, Citerio G, et al. Consensus Summary Statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care. Neurocrit Care. 2014; 21(S2): pp. 1–26. doi: 10.1007/s12028-014-0041-5.
  • Watson HI, Shepherd AA, Rhodes JKJ, Andrews PJD. Revisited: A Systematic Review of Therapeutic Hypothermia for Adult Patients Following Traumatic Brain Injury. Crit Care Med. 2018; 46(6): pp. 972–979. doi: 10.1097/ccm.0000000000003125.
  • Andrews PJ, Sinclair HL, Rodríguez A, et al. Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: the Eurotherm3235 RCT. Health Technol Assess (Rockv). 2018; 22(45): pp. 1–134. doi: 10.3310/hta22450.
  • Lerner JT, Giza CC. Traumatic Brain Injury in Children. Elsevier; 2017: pp. 781–793.
last updated 07/10/2020
{{uncollapseSections(['npa7Jl', 'opa0ql', 'IScYaX0', '6pajql', 'sSctaX0', 'qpaCql', '7pa4Il', 'GpaBIl', 'bScHyb0', 'AScRXX0', 'Xhc9cX0'])}}