Surgery pp 461-469 | Cite as

Traumatic Brain Injury

  • Kyle Chappie
  • Roger Hartl


Traumatic brain injury (TBI) is graded as mild, moderate, or severe based on the level of consciousness or the Glasgow Coma Scale (GCS) score after resuscitation (Table 26.1). Mild TBI is defined with a GCS score between 13 and 15. In most cases it represents a concussion, and there is full neurological recovery, although many patients reveal short-term memory and concentration deficits. Patients with moderate TBI are typically stuporous and lethargic with a GCS score between 9 and 13. A comatose patient who is unable to open his or her eyes or follow commands has a GCS score of less than 9 and by definition has a severe TBI.


Traumatic Brain Injury Glasgow Coma Scale Intracranial Hypertension Cerebral Perfusion Pressure Hypertonic Saline 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    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;56:492–499.PubMedCrossRefGoogle Scholar
  2. 2.
    Palmer S, Bader M, Qureshi A, et al. The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. American Association for Neurologic Surgeons. J Trauma 2001;50:657–664.PubMedCrossRefGoogle Scholar
  3. 3.
    Guidelines for Prehospital Mangement of Traumatic Brain Injury. New York: Brain Trauma Foundation, 2000.Google Scholar
  4. 4.
    Guidelines for the Management of Severe Traumatic Brain Injury. J Neurotrauma 2000;17:449–554.Google Scholar
  5. 5.
    Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006;21:375–378.PubMedCrossRefGoogle Scholar
  6. 6.
    Sosin D, Sniezek J, Waxweiler R. Trends in death associated with traumatic brain injury. JAMA 1995;273:1778–1780.PubMedCrossRefGoogle Scholar
  7. 7.
    Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma 1996;40:764–767.PubMedCrossRefGoogle Scholar
  8. 8.
    Chesnut R, Marshall L, Klauber M, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993;34:216–222.PubMedCrossRefGoogle Scholar
  9. 9.
    Unterberg AW, Stover J, Kress B, et al. Edema and brain trauma. Neuroscience 2004;129:1021–1029.PubMedCrossRefGoogle Scholar
  10. 10.
    Narayan RK, Michel ME, Ansell B, et al. Clinical trials in head injury. J Neurotrauma 2002;19:503–557.PubMedCrossRefGoogle Scholar
  11. 11.
    The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring. J Neurotrauma 2000;17:479–491.CrossRefGoogle Scholar
  12. 12.
    Update Notice. Guidelines for the management of severe traumatic brain injury: cerebral perfusion pressure. Neurotrauma Crit Care News 2004;7:3.Google Scholar
  13. 13.
    Robertson CS, Valadka AB, Hannay HJ, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med 1999;27:2086–2095.PubMedCrossRefGoogle Scholar
  14. 14.
    The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Hyperventilation. J Neurotrauma 2000;17:513–520.CrossRefGoogle Scholar
  15. 15.
    Battison C, Andrews PJ, Graham C, et al. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med 2005;33:196–202.PubMedCrossRefGoogle Scholar
  16. 16.
    Hard R, Ghajar J, Hochleuthner H, et al. Hypertonic/hyperoncotic saline reliably reduces ICP in severely head-injured patients with intracranial hypertension. Acta Neurochir Suppl (Wien) 1997;70:126–129.Google Scholar
  17. 17.
    Horn P, Munch E, Vajkoczy P, et al. Hypertonic saline solution for control of elevated intracranial pressure in patients with exhausted response to mannitol and barbiturates. Neurol Res 1999;21:758–764.PubMedGoogle Scholar
  18. 18.
    Munar F, Ferrer AM, de Nadal M, et al. Cerebral hemodynamic effects of 7.2% hypertonic saline in patients with head injury and raised intracranial pressure. J Neurotrauma 2000;17:41–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Qureshi Al, Suarez JI, Bhardwaj A, et al. Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: effect on intracranial pressure and lateral displacement of the brain. Crit Care Med 1998;26:440–446.PubMedCrossRefGoogle Scholar
  20. 20.
    Qureshi Al, Suarez JI, Castro A, et al. Use of hypertonic saline/acetate infusion in treatment of cerebral edema in patients with head trauma: experience at a single center. J Trauma 1999;47:659–665.PubMedCrossRefGoogle Scholar
  21. 21.
    Schatzmann C, Heissler HE, Konig K, et al. Treatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients. Acta Neurochir Suppl (Wien) 1998;71:31–33.PubMedGoogle Scholar
  22. 22.
    Shackford SR, Bourguignon PR, Wald SL, et al. Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. J Trauma 1998;44:50–58.PubMedCrossRefGoogle Scholar
  23. 23.
    Vialet R, Albanese J, Thomachot L, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2mL/kg 7.5% saline is more effective than 2mL/kg 20% mannitol. Crit Care Med 2004;31:1683–1687.CrossRefGoogle Scholar
  24. 24.
    Edwards P, Arango M, Balica L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 2005;365:1957–1959.PubMedCrossRefGoogle Scholar
  25. 25.
    Oertel M, Kelly DF, Lee JH, et al. Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury. J Neurosurg 2002;97:1045–1053.PubMedGoogle Scholar
  26. 26.
    Cohen J, Montero A, Israel Z. Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients. J Trauma 1996;41:120–122.PubMedCrossRefGoogle Scholar
  27. 27.
    Haselsberger K, Pucher R, Auer L. Prognosis after acute subdural or epidural haemorrhage. Acta Neurochir (Wien) 1988;90:111–116.CrossRefGoogle Scholar
  28. 28.
    Lee E, Hung Y, Wang L, et al. Factors influencing the functional outcome of patients with acute epidural hematomas: analysis of 200 patients undergoing surgery. J Trauma 1998;45:B946–B952.CrossRefGoogle Scholar
  29. 29.
    Sakas D, Bullock M, Teasdale G. One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils. J Neurosurg 1995;82:961–965.PubMedCrossRefGoogle Scholar
  30. 30.
    Wilberger JJ, Harris M, Diamond D. Acute subdural hematoma: morbidity and mortality related to timing of operative intervention. J Trauma 1990;30:F733–F736.CrossRefGoogle Scholar
  31. 31.
    Jiang JY, Gao GY, Li WP, et al. Early indicators of the prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 2002;19:869–874.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Kyle Chappie
    • 1
  • Roger Hartl
    • 2
  1. 1.Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Neurological SurgeryWeill Cornell Medical CollegeNew YorkUSA

Personalised recommendations