A review of current practice in the management of traumatic brain injury at the acute stage highlights both the shortcomings of current methods and the potential for radical improvement. The article, published in the latest edition of the journal Trauma, looks at treatment practice for patients with severe traumatic brain injury at the acute stage, with particular attention to strategies that have been proven to minimise secondary brain injury.
Severe traumatic brain injury rarely occurs without accompanying injuries, which, for a number of reasons, can lead to secondary brain injuries. For example, an increase or decrease in blood pressure in the brain can lead to the widespread death of brain cells. Facial injury can lead to the obstruction of the airways and cause hypoxic injury due to lack of oxygen, which can also be caused by injuries to the heart and lungs.
There are over 1000 cases of severe trauma per week in the UK, with up to 60% sustaining head injury. A recent UK national outcome review of trauma services highlighted room for improvement in over half of centres in the management of head injury specifically and, while little can be done to alter the primary injury, effective management to reduce secondary injury can significantly improve outcome.
Much previous research has focused on the identification of pharmacological agents aimed at the reduction of secondary injuries. However, this report highlights the importance of the early introduction of simple measures, such as the reduction of pressure in the skull and early neurosurgical treatment, which are currently available in less than half of cases.
Reference
Cowley & da Silva (2008). Prevention of secondary brain injury following Head Trauma, Trauma, Vol. 10, No. 1, pp. 35 - 42
Back