Guidelines for Severe Traumatic Brain Injury: 4th edition


Approximately 2.5 million Americans annually suffer traumatic brain injury (TBI). Severe TBI causes more than 30 percent of all injury-related deaths in the U.S. and account for 90 percent of the nearly $80 billion in annual costs. The new Guidelines for the Management of Severe Traumatic Brain Injury were recently introduced, providing 28 recommendations for 18 monitoring and treatment topics, including surgical procedures, the use of monitors that measure intracranial pressure, preventing and treating brain swelling, and nutrition, with 14 new or changed recommendations and 14 unchanged recommendations; 7 previous recommendations were removed after failing to meet current standards. In addition, the guidelines do not include recommendations in many key areas because of lack of evidence. Another key criticism is that although topics such as intracranial pressure (ICP) monitoring is addressed, no recommendations on how monitoring information should inform clinical management. The authors also state that they plan to continuously monitor biomedical literature, rapidly review new evidence and revise recommendations on an ongoing basis as "Living Guidelines". Clinicians will still need to use their practical experience in specific clinical settings to derive treatment algorithms. Treating physicians should go to for updates.

Roland Torres, MD
Iowa City, IA