TRAUMATIC BRAIN INJURY STUDY HIGHLIGHTS – Updated Review of the Management of and Guidelines for Traumatic Brain Injury by Rapp, A., et al.

Traumatic brain injury (TBI) remains a major global cause of death and disability. Recent advances come from a deeper understanding of primary (mechanical) and secondary (metabolic, ischemic, and inflammatory) injury processes. This updated review summarises key evidence and the latest international guidelines, including the 2020 Brain Trauma Foundation (BTF) recommendations.

𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀 & 𝗖𝘂𝗿𝗿𝗲𝗻𝘁 𝗚𝘂𝗶𝗱𝗲𝗹𝗶𝗻𝗲𝘀:⁣
𝗦𝘂𝗿𝗴𝗶𝗰𝗮𝗹 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁⁣
• Late decompressive craniectomy (>24h) lowers mortality but increases severe disability.
• Early decompression (<24h) shows no improved outcomes.
• Large fronto-temporo-parietal craniotomy (≥12×15 cm) improves intracranial pressure (ICP) control and survival.
• RESCUE-ASDH: no major difference between craniectomy vs craniotomy for acute subdural hematoma—decisions should be individualised.

𝗠𝗲𝗱𝗶𝗰𝗮𝗹 / 𝗜𝗻𝘁𝗲𝗻𝘀𝗶𝘃𝗲 𝗖𝗮𝗿𝗲 𝗨𝗻𝗶𝘁 (𝗜𝗖𝗨) 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁⁣
• Target ICP <22 mmHg; maintain CPP 60–70 mmHg.
• Osmotherapy, sedation, and controlled hyperventilation remain key tools.
• Normothermia preferred—therapeutic hypothermia offers no proven benefit.
• Advanced neuromonitoring is useful but limited to specialised centres.

𝗣𝗿𝗲𝗵𝗼𝘀𝗽𝗶𝘁𝗮𝗹 & 𝗦𝘂𝗽𝗽𝗼𝗿𝘁𝗶𝘃𝗲 𝗖𝗮𝗿𝗲⁣
• Early airway protection and avoidance of hypoxia/hypotension significantly improve outcomes.
• Rehabilitation starts in the ICU—addressing cognitive, psychological, and physical recovery.
• Post-traumatic epilepsy affects up to 20% of survivors; early anticonvulsant prophylaxis is standard.

𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆𝘀:⁣
The management of TBI is evolving towards individualised and evidence-based treatments that balance intensive care with improvements in long-term quality of life. The 2020 BTF guidelines serve as the basis for these data, which are regularly updated and supported by numerous major clinical trials.

📄 Access the full article at: Rapp, A., Kobeissi, H., & Fahim, D. K. (2025). Updated Review of the Management of and Guidelines for Traumatic Brain Injury. Journal of Clinical Medicine, 14(19), 6796. https://www.mdpi.com/2077-0383/14/19/6796. This is an open-access article under a CC-BY 4.0 license.