Traumatic brain injury- A case―based review.docVIP

Traumatic brain injury: A case―based review 　　BACKGROUND： Traumatic brain injuries are common and costly to hospital systems. Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines. This is a review of the current literature discussing the evolving practice of traumatic brain injury. DATA SOURCES： A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses， systematic reviews， and randomized controlled trials. RESULTS： The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas， maintain systolic blood pressure above 90 mmHg， oxygen saturations above 93%， euthermia， intracranial pressures below 20 mmHg， and cerebral perfusion pressure between 60?80 mmHg. CONCLUSION： Much is still unknown about the management of traumatic brain injury. The current practice guidelines have not yet been sufficiently validated， however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury. KEY WORDS： Traumatic brain injury； Emergency departments； Glascow Coma Scale World J Emerg Med 2013；4（4）：252?259 DOI： 10.5847/ wjem.j.1920?8642.2013.04.002 BACKGROUND Over 1.7 million people present to US emergency departments （EDs） after sustaining traumatic brain injury （TBI） each year.[1] Of those， approximately 52 000 will die， 275 000 are hospitalized， and 1.4 million are evaluated and discharged from an EDs.[1] Distribution of age is trimodal with predominance in the age groups of： 0?4 years； 15?19 years； and 65 years. The most common cause is falls followed by motor vehicle crashes and assaults. In the United States， cost of care， which includes loss of productivity， was estimated to be $76.5 billion in 2000.[1] TBI can occur as an isolated injury or as part of multisystem trauma. When compared to other traumatic injuri