Use of Guidelines in the Management of Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is the leading cause of death and disability among children and adults ages 1–44 years. Management of TBI patients has relied on clinical practice guidelines (CPG), which play a pivotal role in their decision-making. Moreover, CPG implementation has been shown to decrease mortality, improve outcomes, and reduce the length of hospital stay. Guidelines published in the United States that are discussed in this chapter include the Brain Trauma Foundation Guidelines (4th Edition Guidelines for the Management of Severe TBI; 2nd Edition Guidelines for the Prehospital Management of TBI; 2nd Edition Guidelines for Severe TBI in Infants, Children, and Adolescents; Early Indicators of Prognosis in Severe TBI; Guidelines for Field Management of Combat-Related Head Trauma), Guidelines for the Management of Penetrating Brain Injury, Guidelines for Surgical Management of Traumatic Brain Injury, the Neurocritical Care Society Guidelines, and the American College of Surgeons Trauma Quality Improvement Program. The context of each guideline is discussed in detail with summary recommendations, classification of evidence, and limitations. Future directions are discussed as they pertain to systematic processes for developing a research agenda to answer key questions and attain better quality evidence to support recommendations.