Management of head injury in the intensive-care unit

Abstract

Approximately one million patients present to hospital in the UK each year having suffered a head injury. The vast majority of these patients have minor (GCS 13–15) or moderate injuries (GCS 9–12) and approximately half are less than 16 yrs old. In adults the age distribution is bimodal, comprising young people (15–29 yrs) involved in road traffic accidents (responsible for approximately 50% of head injuries) and elderly people involved in domestic accidents. Overall, males are 2–3 times more likely to have a head injury than females. Head injury is associated with tremendous mortality and morbidity. One percent of all deaths in the UK are attributed to head injury; up to 85% of all severely head-injured patients remain disabled after 1 yr and only 15% have returned to work at 5 yrs. Even after apparently mild head injury, nearly 50% of patients have moderate or severe disability 1 yr later and only 45% return to full functional activity. Therefore, for both individual and economic reasons, small improvements in the management of head-injured patients may have a great effect on outcome. This article will address the main principles of head-injury management in the intensive-care unit (ICU) after severe isolated traumatic brain injury, the use of additional monitoring devices and alternative management protocols. Some of the pitfalls and failures of head-injury research and some of the potential areas of future development are discussed. The management of patients with multiple trauma will not be addressed.