Updated Review of the Management of and Guidelines for Traumatic Brain Injury
Aaron Rapp, Hassan Kobeissi, Daniel K. Fahim
Abstract
Traumatic brain injury (TBI) remains a leading cause of mortality and disability globally, necessitating ongoing research into its pathophysiology and management. This review compiles current knowledge on TBI, focusing on its mechanisms, updated clinical guidelines, and recent clinical trials. A systematic PubMed search identified studies on TBI management, guidelines, and trials from 2015 to 2024. TBI initiates with a primary mechanical insult, followed by secondary injury from cerebral edema, elevated intracranial pressure (ICP), and ischemia. Management hinges on stabilizing patients, mitigating secondary injury, and optimizing recovery, guided by the Brain Trauma Foundation's 2020 guidelines. Key trials, including Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension (RESCUEicp) and Decompressive Craniectomy in Diffuse Traumatic Brain Injury (DECRA), have refined recommendations for decompressive craniectomy, though its role remains debated. Findings indicate that large craniectomies improve mortality in late refractory ICP cases, but early intervention lacks clear benefits. Challenges include access to advanced monitoring and surgical expertise. This review underscores the evolving nature of TBI care and the need for dynamic guidelines to improve patient outcomes.