Advances in Traumatic Brain Injury Care: A Problem-Solving Approach for a Heterogeneous Syndrome

Abstract

Although the definition of traumatic brain injury (TBI) tends to vary according to specialties and circumstances, it is generally accepted that “TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force” (Menon et al., Arch Phys Med Rehabil 91(11):1637-40, 2010). Head injury patients are heterogeneous (Maas et al. Lancet Neurol. 7(8):728-41, 2008; Saatman et al. J Neurotrauma. 25(7):719-38, 2008), and their care must take account of their age, neurology, imaging, and associated injuries. TBI management is complex and must be specific in each step of the acute phase. The first few hours are extremely important not only for survival but also because the physician must respond to potential life-threatening changes and take all possible measures to reduce both secondary damage and disability. Understanding the physiology of TBI is important because there is minimal monitoring in the acute phase. Consequently, it may be useful to translate the common practice acquired in the neurointensive care unit (Stocchetti et al. Lancet Neurol. 16(6):452-64, 2017) to the early extra-hospital and emergency room phases. The people who care the very initial phase could improve their knowledge of the different clinical patterns following-up the patients in the early few days and weeks after hospital admission. Outcomes at 6 months should also be recorded, to benchmark the acute care and record the patient’s quality of life. This chapter focuses on these heterogeneities and on the sequential phases of patient care, assessing some practical skills. It also focuses on suggestions for the sequential problem-solving approach typical of trauma patient management.