Chapter 22 - Clinical risk factors of traumatic brain injury

Abstract

Traumatic brain injury represents a major economic and sociologic burden. The use of clinical risk factors to prospectively stratify patients into cohorts of injury severity is valuable. The most commonly used risk scoring systems are the Glasgow Coma Scale (GCS) and the Full Outline of UnResponsiveness (FOUR) score. In addition, neuroimaging risk stratification tools include the Marshall scale and the Rotterdam scale, which also are prospective determinants of injury severity. Beyond the initial damage, avoidance of secondary brain injury is critical, including the prevention of hypoxia, hypotension, and hypothermia, which can also be included in outcome predictors. Other predictors of poor outcomes may include elevated biomarkers, such as S-100βprotein, CSFα-synuclein, and NSE. Finally, there are outcome prediction models for patients with traumatic brain injury that sum many of the above described factors. These include the CRASH model that incorporates GCS, age, pupils, extracranial injury, country, and CT findings, and the IMPACT model of pupils, GCS motor response, age, CT imaging hypotension, hypoxemia, hemoglobin, and glucose levels. This chapter reviews the data supporting the use of these various risk stratification tools.