Each year, an estimated 1.7 million people sustain a traumatic brain injury (TBI). Of these, 275,000 people are hospitalized. The severity of TBI may range from “mild” (a brief change in mental status or consciousness) to “severe” (comatose state, defined as a Glasgow Coma Scale (GCS) Score less than or equal to 8. The effects resulting from TBI may include short term and long-term functional changes affecting memory, reasoning, sensation, expressing and understanding language, and mood and behavior.
One of the major advances over the past two decades in the care of patients with severe head injury has been the development of standardized approaches that follow international and national guidelines. Several studies support evidence that treatment in centers with neurosurgical support, especially in settings where protocol-driven neurointensive care units operate based on recommendations from published guidelines, are associated with better patient outcomes. Many expert panels recommend that treatment of severe TBI should be centralized in large trauma centers that offer neurosurgical treatment and access to specialized neurocritical care.
The critical care management of severe TBI is largely derived from the "Guidelines for the Management of Severe Traumatic Brain Injury" that have been published by the Brain Trauma Foundation. The main objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion, and optimization of cerebral oxygenation
Mild-Moderate TBI, Post-Concussion Syndrome
The distinction between mild and moderate head injuries is based on the initial Glasgow Coma Scale score and appearance of the initial CT scan of the head. Patients who have an initial GCS score of 13 to 15 are considered to have a mild brain injury. Those patients with a GCS score of 9 to 12 are classified as having a moderate brain injury. Most patients with mild head injurycan be observed safely in the emergency department and discharged, although a few are at risk for delayed posttraumatic intracerebral hematomas or brain swelling. Identification of these patients requires careful neurologic assessment and liberal use of the CT scan.
Post-concussion syndrome can result from relatively minor head injuries, and most commonly involves headaches, tinnitus, vertigo, gait unsteadiness, emotional lability, sleep disturbances, intermittent blurring of vision, and irritability. Symptoms can continue for weeks, months, or several years, but are rarely permanent. Beta-blocking agents, tricyclic antidepressants, or nonsteroidal anti-inflammatory agents may be beneficial, as well as psychotherapy and physical therapy.
For more information on the neurotrauma services at UPMC Presbyterian, please visit the Trauma Unit Information page on the UPMC Presbyterian website. Here you find information on our facilities and other patient and visitor resources.
Brain and Spine Injury
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