Standards and guidelines for the management of severe head injury

Abstract

To standardize the care and management of patients with severe head injury may reduce inappropriate care and improve patient outcomes. The optimum guidelines also may reduce the cost of medical care and enhance quality of the management. Recently 2 major sets of guidelines were presented using a different approach. One from the Brain Trauma Foundation of the United State in 1995 and the other from the European Brain Injury Consortium in 1997. The former was developed by evaluating the scientific evidence (evidence-based guideline) and the latter was based on the expert opinion and committee consensus (consensus-based guideline). The major topics of these guidelines are trauma care system, prehospital care and ICU managements, which are deemed to have an impact on outcomes of patients with Glasgow Coma Scale (GCS) score of 8 or less in adults. Despite the contrasting methods used to develop these guidelines, they are nearly the same in essence. In this article, each topics of both guidelines are generally reviewed. Our updating protocol for the management of severe head injury including hypothermia therapy and the preliminary result are described. In addition, controversies on management guidelines are also discussed.