<< Severe Traumatic Brain Injury In Adults (Trauma CME)


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized,
and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study will be included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

  1. Faul M, Xu L, Wald M, et al. Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2010. (Government report)
  2. US Department of Defense. Report to Congress On Expenditures for Activities on Traumatic Brain Injury and Psychological Health, Including Posttraumatic Stress Disorder, for 2010. Available at: http://www.tricare.mil/tma/congressionalinformation/downloads/Reports-Section1634b.pdf. Accessed November 11, 2012.
  3. Finkelstein EA, Corso PS, Miller TR. Incidence and Economic Burden of Injuries in the United States. Oxford University Press, USA; 2006.
  4. Kochanek P, Berger RP, Margulies SS, et al. Inflicted childhood neurotrauma: new insight into the detection, pathobiology, prevention, and treatment of our youngest patients with traumatic brain injury. J Neurotrauma. 2007;24(1):1-4. (Review)
  5. Chesnut R. Care of central nervous system injuries. Surg Clin North Am. 2007;87(1):119-156. (Review)
  6. * Badjatia N, Carney N, Crocco TJ, et al. Guidelines for prehospital management of traumatic brain injury, 2nd edition. Prehosp Emerg Care. 2008;12 Suppl 1:S1-S52. (Guidelines)
  7. * The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24 Suppl 1:S14-S20. (Guidelines)
  8. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of TBI. Neurosurgery. 2006;58(3 Suppl):S1-S61. (Guidelines)
  9. Chesnut RM, Ghajar J, Maas AIR, et al. Brain Trauma Foundation. Early indicators of prognosis in severe traumatic brain injury. 2000. Available at: https://www.braintrauma. org/coma-guidelines/searchable-guidelines/. Accessed November 11, 2012. (Guideline)
  10. Watts DD, Hanfling D, Waller MA, et al. An evaluation of the use of guidelines in prehospital management of brain injury. Prehosp Emerg Care. 2004;8(3):254-261. (Prospective; 1044 patients)
  11. Arabi YM, Haddad S, Tamim HM, et al. Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury. J Crit Care. 2010;25(2):190-195. (Retrospective; 434 patients)
  12. Faul M, Wald MM, Rutland-Brown W, et al. Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing the Brain Trauma Foundation guidelines for the treatment of severe traumatic brain injury. J Trauma. 2007;63(6):1271-1278. (Retrospective; 226,974 patients)
  13. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16-S24. (Guidelines)
  14. * Zumkeller M, Behrmann R, Heissler HE, et al. Computed tomographic criteria and survival rate for patients with acute subdural hematoma. Neurosurgery. 1996;39(4):708-712. (Retrospective; 174 patients)
  15. Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493-1502. (Prospective randomized controlled; 155 patients)
  16. Greenberg M. Handbook of Neurosurgery. Lakeland, FL: Greenberg Graphics; 1997.
  17. Servadei F, Murray GD, Teasdale GM, et al. Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 patients from the European Brain Injury Consortium survey of head injuries. Neurosurgery. 2002;50(2):261-267. (Prospective; 750 patients)
  18. Oertel M, Boscardin WJ, Obrist WD, et al. Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. J Neurosurg. 2005;103(5):812-824. (Prospective; 299 patients)
  19. Oertel M, Kelly DF, McArthur D, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96(1):109-116. (Retrospective; 142 patients)
  20. Iwata A, Stys PK, Wolf JA, et al. Traumatic axonal injury induces proteolytic cleavage of the voltage-gated sodium channels modulated by tetrodotoxin and protease inhibitors. J Neurosci. 2004;24(19):4605-4613. (Basic science)
  21. Stuehmer C, Blum KS, Kokemueller H, et al. Influence of different types of guns, projectiles, and propellants on patterns of injury to the viscerocranium. J Oral Maxillofac Surg. 2009;67(4):775-781. (Case series; 14 patients)
  22. Feldman Z, Narayan RK, Robertson CS. Secondary insults associated with severe closed head injury. Contemporary Neurosurgery. 1992;14(4):1-8. (Review)
  23. No authors listed. Antibiotic prophylaxis for penetrating brain injury. J Trauma. 2001;51(2 Suppl):S34-S40. (Review)
  24. Martin EM, Lu WC, Helmick K, et al. Traumatic brain injuries sustained in the Afghanistan and Iraq wars. Am J Nurs. 2008;108(4):40-47. (Case report and review)
  25. Howells T, Elf K, Jones PA, et al. Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg. 2005;102(2):311-317. (Retrospective; 131 patients)
  26. White H, Venkatesh B. Cerebral perfusion pressure in neurotrauma: a review. Anesth Analg. 2008;107(3):979-988. (Review)
  27. Steiner LA, Czosnyka M, Piechnik SK, et al. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002;30(4):733-738. (Retrospective; 114 patients)
  28. Stein DM, Hu PF, Brenner M, et al. Brief episodes of intracranial hypertension and cerebral hypoperfusion are associated with poor functional outcome after severe traumatic brain injury. J Trauma. 2011;71(2):364-373. (Prospective; 60 patients)
  29. Kahraman S, Hu P, Stein DM, et al. Dynamic three-dimensional scoring of cerebral perfusion pressure and intracranial pressure provides a brain trauma index that predicts outcome in patients with severe traumatic brain injury. J Trauma. 2011;70(3):547-553. (Prospective; 60 patients)
  30. Juul N, Morris GF, Marshall SB, et al. Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg. 2000;92(1):1-6. (Prospective; 427 patients)
  31. Zweinenberg M, Muizelaar J. Vascular aspects of severe head injury. In: Miller LP, Hayes RL, Newcomb JK, eds. Head Trauma: Basic, Preclinical, and Clinical Directions. New York: Wiley; 2001:303-326. (Textbook)
  32. Heegaard W, Biros M. Traumatic brain injury. Emerg Med Clin North Am. 2007;25(3):655-678. (Review)
  33. Marmarou A, Signoretti S, Fatouros PP, et al. Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg. 2006;104(5):720-730. (Prospective; 52 patients)
  34. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81-84. (Descriptive)
  35. Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien). 1976;34(1-4):45-55. (Retrospective; 92 patients)
  36. Narayan RK, Greenberg RP, Miller JD, et al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981;54(6):751-762. (Prospective; 133 patients)
  37. Corrigan JD, Rust E, Lamb-Hart GL. The nature and extent of substance abuse problems in persons with traumatic brain injury. J Head Trauma Rehab. 1995;10(3):29-46. (Review)
  38. Tien HC, Tremblay LN, Rizoli SB, et al. Association between alcohol and mortality in patients with severe traumatic head injury. Arch Surg. 2006;141(12):1185-1191. (Retrospective; 1158 patients)
  39. Brady WJ, Butler K, Fines R, et al. Hypoglycemia in multiple trauma victims. Am J Emerg Med. 1999;17(1):4-5. (Retrospective; 926 patients)
  40. Berry C, Ley EJ, Bukur M, et al. Redefining hypotension in traumatic brain injury. Injury. 2011. (Retrospective; 15,733 patients)
  41. Eastridge BJ, Salinas J, McManus JG, et al. Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma. 2007;63(2):291-297. (Retrospective; 870,634 patients)
  42. Wade CE, Grady JJ, Kramer GC, et al. Individual patient cohort analysis of the efficacy of hypertonic saline/dextran in patients with traumatic brain injury and hypotension. J Trauma. 1997;42(5 Suppl):S61-S65. (Meta-analysis; 223 patients)
  43. Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004;291(11):1350-1357. (Prospective randomized controlled; 229 patients)
  44. * Bulger EM, May S, Brasel KJ, et al. Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. JAMA. 2010;304(13):1455-1464. (Prospective randomized controlled; 1331 subjects)
  45. Davis DP, Dunford JV, Poste JC, et al. The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma. 2004;57(1):1-8. (Prospective; 603 patients)
  46. Chi JH, Knudson MM, Vassar MJ, et al. Prehospital hypoxia affects outcome in patients with traumatic brain injury: a prospective multicenter study. J Trauma. 2006;61(5):1134-1141. (Prospective; 671 patients)
  47. Klemen P, Grmec S. Effect of pre-hospital advanced life support with rapid sequence intubation on outcome of severe traumatic brain injury. Acta Anaesthesiol Scand. 2006;50(10):1250-1254. (Prospective; 124 patients)
  48. Wang HE, Peitzman AB, Cassidy LD, et al. Out-of-hospital endotracheal intubation and outcome after traumatic brain injury. Ann Emerg Med. 2004;44(5):439-450. (Retrospective; 4098 patients)
  49. Davis DP, Ochs M, Hoyt DB, et al. Paramedic-administered neuromuscular blockade improves prehospital intubation success in severely head-injured patients. J Trauma. 2003;55(4):713-719. (Prospective; 438 patients)
  50. Davis DP, Dunford JV, Ochs M, et al. The use of quantitative end-tidal capnometry to avoid inadvertent severe hyperventilation in patients with head injury after paramedic rapid sequence intubation. J Trauma. 2004;56(4):808-814. (Prospective; 426 patients)
  51. Winchell RJ, Hoyt DB. Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma Research and Education Foundation of San Diego. Arch Surg. 1997;132(6):592-597. (Retrospective; 671 patients)
  52. * Davis DP, Hoyt DB, Ochs M, et al. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma. 2003;54(3):444-453. (Prospective; 846 patients)
  53. Bernard SA, Nguyen V, Cameron P, et al. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial. Ann Surg. 2010;252(6):959-965. (Prospective randomized controlled; 312 patients)
  54. Brorsson C, Rodling-Wahlstrom M, Olivecrona M, et al. Severe traumatic brain injury: consequences of early adverse events. Acta Anaesthesiol Scand. 2011;55(8):944-951. (Prospective; 48 patients)
  55. Dumont TM, Visioni AJ, Rughani AI, et al. Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma. 2010;27(7):1233-1241. (Retrospective; 77 patients)
  56. Marion DW, Puccio A, Wisniewski SR, et al. Effect of hyperventilation on extracellular concentrations of glutamate, lactate, pyruvate, and local cerebral blood flow in patients with severe traumatic brain injury. Crit Care Med. 2002;30(12):2619-2625. (Prospective; 20 patients)
  57. Hunt J, Hill D, Besser M, et al. Outcome of patients with neurotrauma: the effect of a regionalized trauma system. Aust N Z J Surg. 1995;65(2):83-86. (Prospective; 88 patients)
  58. Davis DP, Peay J, Serrano JA, et al. The impact of aeromedical response to patients with moderate to severe traumatic brain injury. Ann Emerg Med. 2005;46(2):115-122. (Retrospective; 10,314 patients)
  59. Siegel JH. The effect of associated injuries, blood loss, and oxygen debt on death and disability in blunt traumatic brain injury: the need for early physiologic predictors of severity. J Neurotrauma. 1995;12(4):579-590. (Retrospective; 4590 patients)
  60. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma. 1996;40(5):764-767. (Prospective; 49 patients)
  61. Davis DP, Vadeboncoeur TF, Ochs M, et al. The association between field Glasgow Coma Scale score and outcome in patients undergoing paramedic rapid sequence intubation. J Emerg Med. 2005;29(4):391-397. (Retrospective; 412 patients)
  62. * White PF, Schlobohm RM, Pitts LH, et al. A randomized study of drugs for preventing increases in intracranial pressure during endotracheal suctioning. Anesthesiology. 1982;57(3):242-244. (Prospective; 15 patients)
  63. Yano M, Nishiyama H, Yokota H, et al. Effect of lidocaine on ICP response to endotracheal suctioning. Anesthesiology. 1986;64(5):651-653. (Prospective; 9 patients)
  64. Walls R. Rapid sequence intubation. In: Walls R, Murphy M, eds. Emergency Airway Management. 3rd ed. Philadelphia: Lippincott, Williams, and Wilkins; 2008:23. (Textbook)
  65. Jagoda A, Bruns J. Elevated intracranial pressure. In: Walls R, Murphy M, eds. Emergency Airway Management. 3rd ed. Philadelphia: Lippincott, Williams and Wilkins; 2008:350-353. (Textbook)
  66. Adachi YU, Satomoto M, Higuchi H, et al. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anesth Analg. 2002;95(1):233-237. (Prospective, randomized, controlled; 100 patients)
  67. Levitt MA, Dresden GM. The efficacy of esmolol versus lidocaine to attenuate the hemodynamic response to intubation in isolated head trauma patients. Acad Emerg Med. 2001;8(1):19-24. (Prospective, randomized, controlled; 30 patients)
  68. Roberts DJ, Hall RI, Kramer AH, et al. Sedation for critically ill adults with severe traumatic brain injury: a systematic review of randomized controlled trials. Crit Care Med. 2011;39(12):2743-2751. (Systematic review)
  69. Perry JJ, Lee JS, Sillberg VA, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2008(2):CD002788. (Systematic review and meta-analysis; 2690 patients)
  70. Sorensen MK, Bretlau C, Gatke MR, et al. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br J Anaesth. 2012;108(4):682-689. (Prospective randomized controlled; 61 patients)
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  72. Davis DP, Idris AH, Sise MJ, et al. Early ventilation and outcome in patients with moderate to severe traumatic brain injury. Crit Care Med. 2006;34(4):1202-1208. (Retrospective; 3804 patients)
  73. Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34(2):216-222. (Prospective; 717 patients)
  74. Muizelaar JP, Marmarou A, Ward JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg. 1991;75(5):731-739. (Prospective randomized controlled; 113 patients)
  75. Sioutos PJ, Orozco JA, Carter LP, et al. Continuous regional cerebral cortical blood flow monitoring in head-injured patients. Neurosurgery. 1995;36(5):943-949. (Prospective; 56 patients)
  76. Fearnside MR, Cook RJ, McDougall P, et al. The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg. 1993;7(3):267-279. (Prospective; 315 patients)
  77. * Myburgh J, Cooper DJ, Finfer S, et al. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357(9):874-884. (Prospective randomized controlled; 460 patients)
  78. * Contant CF, Valadka AB, Gopinath SP, et al. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg. 2001;95(4):560-568. (Retrospective; 189 patients)
  79. Fakhry SM, Trask AL, Waller MA, et al. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. J Trauma. 2004;56(3):492-499. (Retrospective; 830 patients)
  80. Chesnut RM, Temkin N, Carney N, et al. A trial of intracranial pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471-2481. (Multicenter controlled trial; 324 patients)
  81. Ng I, Lim J, Wong HB. Effects of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation. Neurosurgery. 2004;54(3):593-597. (Prospective; 38 patients)
  82. Hsiang JK, Chesnut RM, Crisp CB, et al. Early, routine paralysis for intracranial pressure control in severe head injury: is it necessary? Crit Care Med. 1994;22(9):1471-1476. (Retrospective; 514 patients)
  83. Jones PA, Andrews PJ, Midgley S, et al. Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anesthesiol. 1994;6(1):4-14. (Prospective; 124 patients)
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Publication Information

Christopher Zammit, William A. Knight

Publication Date

March 2, 2013

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