Traumatic brain injury

Abstract

Traumatic brain injury is a leading cause of mortality and long-term disability worldwide. It encompasses a broad spectrum of conditions with pathophysiological heterogeneity. Clinical treatment practices are also heterogenous due to disparities in care between, and within, low- and high-income care settings. Extra-cranial injury, present in half of all patients with severe traumatic brain injury, often associated with high-energy trauma, can cause systemic organ dysfunction and exacerbate secondary brain injury. Preventing this through protocolized assessment and prompt resuscitation remain the focus of the initial phase of care. Neurocritical care management of traumatic brain injury is a complex and multifaceted process that requires continuous integration of intracranial and systemic physiological monitoring. Advances in multidimensional frameworks for the characterization of traumatic brain injury, including biomarkers and advanced neuroimaging, may help to individualize therapies. Challenges remain, healthcare inequalities in high-income countries are exacerbated by inadequate focus on low-energy falls in older patients and follow-up in mild traumatic brain injury. In this review, we summarize current approaches to the care of patients with moderate-to-severe injury, with particular emphasis on specialized neurocritical care, and discuss key areas of uncertainty and evolving practice.