Despite being common practice for decades and being recommended by national guidelines, aggressive monitoring and treatment of patients with severe traumatic brain injury (TBI) have not been supported by convincing evidence.
The authors reviewed trials and case series reported after 1970 in which patients were treated for severe closed TBI, and mortality rates and favorable outcomes at 6 months after injury were analyzed. The patient groups were divided into those with and without intracranial pressure (ICP) monitoring and intensive therapy, and the authors performed a meta-analysis to assess the effects of treatment intensity on outcome.
Although the mortality rate fell during the years reviewed, it was consistently ~ 12% lower among patients in the intense treatment group (p < 0.001). Favorable outcomes did not change significantly over time, and were 6% higher among the aggressively treated patients (p = 0.0105).
Aggressive ICP monitoring and treatment of patients with severe TBI is associated with a statistically significant improvement in outcome. This improvement occurs independently of temporal effects.
Please include this information when citing this paper: published online September 11, 2009; DOI: 10.3171/2009.8.JNS09738.
Akopian G, , Gaspard DJ, & Alexander M: Outcomes of blunt head trauma without intracranial pressure monitoring. Am Surg 73:447–450, 2007
Alberico AM, , Ward JD, , Choi SC, , Marmarou A, & Young HF: Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 67:648–656, 1987
Alvarez M, , Nava JM, , Rue M, & Quintana S: Mortality prediction in head trauma patients: performance of Glasgow Coma Score and general severity systems. Crit Care Med 26:142–148, 1998
Andrews PJ, , Sleeman DH, , Statham PF, , McQuatt A, , Corruble V, & Jones PA, et al.: Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: a comparison between decision tree analysis and logistic regression. J Neurosurg 97:326–336, 2002
Athiappan S, , Muthukumar N, & Srinivasan US: Influence of basal cisterns, midline shift and pathology on outcome in head injury. Ann Acad Med Singapore 22:452–455, 1993
Auer L, , Gell G, , Richling B, & Oberbauer R: Predicting outcome after severe head injury—a computer-assisted analysis of neurological symptoms and laboratory values. Acta Neurochir Suppl (Wien) 28:171–173, 1979
Bahloul M, , Chelly H, , Ben Hmida M, , Ben Hamida C, , Ksibi H, & Kallel H, et al.: Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases. J Trauma 57:255–261, 2004
Bang H, & Davis CE: On estimating treatment effects under noncompliance in randomized clinical trials: are intent-to-treat or instrumental variables analyses perfect solutions?. Stat Med 26:954–964, 2007
Baxt WG, & Moody P: The impact of advanced prehospital emergency care on the mortality of severely brain-injured patients. J Trauma 27:365–369, 1987
Becker DP, , Miller JD, , Ward JD, , Greenberg RP, , Young HF, & Sakalas R: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502, 1977
Benzer A, , Traweger C, , Ofner D, , Marosi M, , Luef G, & Schmutzhard E: Statistical modelling in analysis of outcome after trauma Glasgow-Coma-Scale and Innsbruck-Coma-Scale. Anasthesiol Intensivmed Notfallmed Schmerzther 30:231–235, 1995
Born JD: The Glasgow-Liège Scale. Prognostic value and evolution of motor response and brain stem reflexes after severe head injury. Acta Neurochir (Wien) 91:1–11, 1988
Bowers SA, & Marshall LF: Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis. Neurosurgery 6:237–242, 1980
Braakman R: Early prediction of outcome in severe head injury. Acta Neurochir (Wien) 116:161–163, 1992
Braakman R, , Gelpke GJ, , Habbema JD, , Maas AI, & Minderhoud JM: Systematic selection of prognostic features in patients with severe head injury. Neurosurgery 6:362–370, 1980
Brain Trauma Foundation: Guidelines for the Management of Severe Head Injury New York, Brain Trauma Foundation, 1995
Bricolo A, , Turazzi S, , Alexandre A, & Rizzuto N: Decerebrate rigidity in acute head injury. J Neurosurg 47:680–689, 1977
Browne LA: Head injuries 1972–73. Ir Med J 70:197–200, 1977
Buchmann B, , Kaufmann MA, , Scheidegger D, & Gratzl O: Does on-scene resuscitation affect in-hospital “do not resuscitate” decisions and mortality in patients with severe head injuries?. J Trauma 32:459–463, 1992
Bulger EM, , Nathens AB, , Rivara FP, , Moore M, , MacKenzie EJ, & Jurkovich GJ: Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 30:1870–1876, 2002
Bullock R, & Hesdorffer DC: Corticosteroids in TBI: the wider implications of the CRASH trial. Neurotrauma Crit Care News Fall 3, 6, 2005
Chesnut RM, , Marshall LF, , Klauber MR, , Blunt BA, , Baldwin N, & Eisenberg HM, et al.: The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34:216–222, 1993
Chesnut RM, , Marshall SB, , Piek J, , Blunt BA, , Klauber MR, & Marshall LF: Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl (Wien) 59:121–125, 1993
Cho DY, & Wang YC: Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome. Intensive Care Med 23:77–84, 1997
Choi SC, , Barnes TY, , Bullock R, , Germanson TA, , Marmarou A, & Young HF: Temporal profile of outcomes in severe head injury. J Neurosurg 81:169–173, 1994
Choi SC, , Muizelaar JP, , Barnes TY, , Marmarou A, , Brooks DM, & Young HF: Prediction tree for severely head-injured patients. J Neurosurg 75:251–255, 1991
Choi SC, , Narayan RK, , Anderson RL, & Ward JD: Enhanced specificity of prognosis in severe head injury. J Neurosurg 69:381–385, 1988
Clayton TJ, , Nelson RJ, & Manara AR: Reduction in mortality from severe head injury following introduction of a protocol for intensive care management. Br J Anaesth 93:761–767, 2004
Clifton GL, , Choi SC, , Miller ER, , Levin HS, , Smith KR Jr, & Muizelaar JP, et al.: Intercenter variance in clinical trials of head trauma—experience of the National Acute Brain Injury Study: hypothermia. J Neurosurg 95:751–755, 2001
Clifton GL, , Grossman RG, , Makela ME, , Miner ME, , Handel S, & Sadhu V: Neurological course and correlated computerized tomography findings after severe closed head injury. J Neurosurg 52:611–624, 1980
Clifton GL, , Miller ER, , Choi SC, & Levin HS: Fluid thresholds and outcome from severe brain injury. Crit Care Med 30:739–745, 2002
Cogbill TH, , Cothren CC, , Ahearn MK, , Cullinane DC, , Kaups KL, & Scalea TM, et al.: Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective. J Trauma 65:994–999, 2008
Colantonio A, , Escobar MD, , Chipman M, , McLellan B, , Austin PC, & Mirabella G, et al.: Predictors of postacute mortality following traumatic brain injury in a seriously injured population. J Trauma 64:876–882, 2008
Colohan AR, , Alves WM, , Gross CR, , Torner JC, , Mehta VS, & Tandon PN, et al.: Head injury mortality in two centers with different emergency medical services and intensive care. J Neurosurg 71:202–207, 1989
Cremer OL: Does ICP monitoring make a difference in neurocritical care?. Eur J Anaesthesiol Suppl 42:87–93, 2008
Cremer OL, , van Dijk GW, , van Wensen E, , Brekelmans GJ, , Moons KG, & Leenen LP, et al.: Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 33:2207–2213, 2005
Davis DP, , Dunford JV, , Poste JC, , Ochs M, , Holbrook T, & Fortlage D, et al.: The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma 57:1–10, 2004
Demetriades D, , Kuncir E, , Murray J, , Velmahos GC, , Rhee P, & Chan L: Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries. J Am Coll Surg 199:216–222, 2004
Eddy VA, , Vitsky JL, , Rutherford EJ, & Morris JA Jr: Aggressive use of ICP monitoring is safe and alters patient care. Am Surg 61:24–29, 1995
Edwards P, , Arango M, , Balica L, , Cottingham R, , El-Sayed H, & Farrell B, et al.: Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 365:1957–1959, 2005
Einarson TR: Pharmacoeconomic applications of meta-analysis for single groups using antifungal onychomycosis lacquers as an example. Clin Ther 19:559–569, 1997
Espersen JO, & Petersen OF: Computerized tomography (CT) in patients with head injuries. Assessment of outcome based upon initial clinical findings and initial CT scans. Acta Neurochir (Wien) 65:81–91, 1982
The European Study Group on Nimodipine in Severe Head Injury: A multicenter trial of the efficacy of nimodipine on outcome after severe head injury. J Neurosurg 80:797–804, 1994
Fakhry SM, , Trask AL, , Waller MA, & Watts DD: Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. J Trauma 56:492–500, 2004
Fearnside MR, , Cook RJ, , McDougall P, & McNeil RJ: The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg 7:267–279, 1993
Feldman Z, , Contant CF, , Robertson CS, , Narayan RK, & Grossman RG: Evaluation of the Leeds prognostic score for severe head injury. Lancet 337:1451–1453, 1991
Flaada JT, , Leibson CL, , Mandrekar JN, , Diehl N, , Perkins PK, & Brown AW, et al.: Relative risk of mortality after traumatic brain injury: a population-based study of the role of age and injury severity. J Neurotrauma 24:435–445, 2007
Gennarelli TA, , Champion HR, , Copes WS, & Sacco WJ: Comparison of mortality, morbidity, and severity of 59,713 head injured patients with 114,447 patients with extracranial injuries. J Trauma 37:962–968, 1994
Gennarelli TA, , Spielman GM, , Langfitt TW, , Gildenberg PL, , Harrington T, & Jane JA, et al.: Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg 56:26–32, 1982
Ghogawala Z, , Barker FG II, & Carter BS: Clinical equipoise and the surgical randomized controlled trial. Neurosurgery 62:N9–N10, 2008
Gibson RM, & Stephenson GC: Aggressive management of severe closed head trauma: time for reappraisal. Lancet 2:369–371, 1989
Gómez PA, , Lobato RD, , Boto GR, , De la Lama A, , González PJ, & de la Cruz J: Age and outcome after severe head injury. Acta Neurochir (Wien) 142:373–381, 2000
Gordon E, , von Holst H, & Rudehill A: Outcome of head injury in 2298 patients treated in a single clinic during a 21-year period. J Neurosurg Anesthesiol 7:235–247, 1995
Greenberg RP, , Newlon PG, , Hyatt MS, , Narayan RK, & Becker DP: Prognostic implications of early multimodality evoked potentials in severely head-injured patients. A prospective study. J Neurosurg 55:227–236, 1981
Greene KA, , Marciano FF, , Johnson BA, , Jacobowitz R, , Spetzler RF, & Harrington TR: Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part I: A proposed computerized tomography grading scale. J Neurosurg 83:445–452, 1995
Hartl R, , Gerber LM, , Iacono L, , Ni Q, , Lyons K, & Ghajar J: Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma 60:1250–1256, 2006
Healey C, , Osler TM, , Rogers FB, , Healey MA, , Glance LG, & Kilgo PD, et al.: Improving the Glasgow Coma Scale score: motor score alone is a better predictor. J Trauma 54:671–680, 2003
Heiden JS, , Small R, , Caton W, , Weiss M, & Kurze T: Severe head injury. Clinical assessment and outcome. Phys Ther 63:1946–1951, 1983
Hesdorffer DC, & Ghajar J: Marked improvement in adherence to traumatic brain injury guidelines in United States trauma centers. J Trauma 63:841–848, 2007
Howard JL, , Cipolle MD, , Anderson M, , Sabella V, , Shollenberger D, & Li PM, et al.: Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. J Trauma 65:380–386, 2008
Hsiao KY, , Hsiao CT, , Weng HH, , Chen KH, , Lin LJ, & Huang YM: Factors predicting mortality in victims of blunt trauma brain injury in emergency department settings. Emerg Med J 25:670–673, 2008
Hyam JA, , Welch CA, , Harrison DA, & Menon DK: Case mix, outcomes and comparison of risk prediction models for admissions to adult, general and specialist critical care units for head injury: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care 10:Suppl 2 S2, 2006
Jennett B, & Bond M: Assessment of outcome after severe brain damage. Lancet 1:480–484, 1975
Jennett B, , Murray A, , Carlin J, , McKean M, , MacMillan R, & Strang I: Head injuries in three Scottish neurosurgical units. Scottish head injury management study. BMJ 2:955–958, 1979
Jennett B, , Teasdale G, , Braakman R, , Minderhoud J, , Heiden J, & Kurze T: Prognosis of patients with severe head injury. Neurosurgery 4:283–289, 1979
Jennett B, , Teasdale G, , Braakman R, , Minderhoud J, & Knill-Jones R: Predicting outcome in individual patients after severe head injury. Lancet 1:1031–1034, 1976
Jennett B, , Teasdale G, , Galbraith S, , Pickard J, , Grant H, & Braakman R, et al.: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291–298, 1977
Jiang JY, , Gao GY, , Li WP, , Yu MK, & Zhu C: Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 19:869–874, 2002
Judson JA, , Cant BR, & Shaw NA: Early prediction of outcome from cerebral trauma by somatosensory evoked potentials. Crit Care Med 18:363–368, 1990
Kagan RJ, & Baker RJ: The impact of the volume of neurotrauma experience on mortality after head injury. Am Surg 60:394–400, 1994
Kim Y, , Jung KY, , Kim CY, , Kim YI, & Shin Y: Validation of the International Classification of Diseases 10th Editionbased Injury Severity Score (ICISS). J Trauma 48:280–285, 2000
King JT Jr, , Glick HA, , Mason TJ, & Flamm ES: Elective surgery for asymptomatic, unruptured, intracranial aneurysms: a costeffectiveness analysis. J Neurosurg 83:403–412, 1995
Klauber MR, , Barrett-Connor E, , Marshall LF, & Bowers SA: The epidemiology of head injury: a prospective study of an entire community—San Diego County, California, 1978. Am J Epidemiol 113:500–509, 1981
Kobayashi S, , Nakazawa S, & Otsuka T: Clinical value of serial computed tomography with severe head injury. Surg Neurol 20:25–29, 1983
Kraus JF, , Peek-Asa C, & McArthur D: The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus 8:1 e5, 2000
Lane PL, , Skoretz TG, , Doig G, & Girotti MJ: Intracranial pressure monitoring and outcomes after traumatic brain injury. Can J Surg 43:442–448, 2000
Langfitt TW, & Gennarelli TA: Can the outcome from head injury be improved?. J Neurosurg 56:19–25, 1982
Langlois JA, , Rutland-Brown W, & Thomas KE: Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths Atlanta, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2004
Lannoo E, , Van Rietvelde F, , Colardyn F, , Lemmerling M, , Vandekerckhove T, & Jannes C, et al.: Early predictors of mortality and morbidity after severe closed head injury. J Neurotrauma 17:403–414, 2000
Lee A, , Garner A, , Fearnside M, & Harrison K: Level of prehospital care and risk of mortality in patients with and without severe blunt head injury. Injury 34:815–819, 2003
Lee ST, , Lui TN, , Chang CN, , Wang DJ, , Heimburger RF, & Fai HD: Features of head injury in a developing country—Taiwan (1977–1987). J Trauma 30:194–199, 1990
Leitgeb J, , Erb K, , Mauritz W, , Janciak I, , Wilbacher I, & Rusnak M: Severe traumatic brain injury in Austria V: CT findings and surgical management. Wien Klin Wochenschr 119:56–63, 2007
Levati A, , Farina ML, , Vecchi G, , Rossanda M, & Marrubini MB: Prognosis of severe head injuries. J Neurosurg 57:779–783, 1982
Lipper MH, , Kishore PR, , Enas GG, , Domingues da Silva AA, , Choi SC, & Becker DP: Computed tomography in the prediction of outcome in head injury. AJR Am J Roentgenol 144:483–486, 1985
Liu HM, , Tu YK, & Su CT: Changes of brainstem and perimesencephalic cistern: dynamic predictor of outcome in severe head injury. J Trauma 38:330–333, 1995
Longhi L, , Pagan F, , Valeriani V, , Magnoni S, , Zanier ER, & Conte V, et al.: Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue. Intensive Care Med 33:2136–2142, 2007
Luerssen TG, , Klauber MR, & Marshall LF: Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. J Neurosurg 68:409–416, 1988
Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 36:1–193, 1960
Maas AI, , Schouten JW, , Stocchetti N, , Bullock R, & Ghajar J: Questioning the value of intracranial pressure (ICP) monitoring in patients with brain injuries. J Trauma 65:966–967, 2008
Marshall LF, , Gautille T, , Klauber MR, , Eisenberg HM, , Jane JA, & Luerssen TG, et al.: The outcome of severe closed head injury. J Neurosurg 75:Suppl 28–36, 1991
Marshall LF, , Smith RW, & Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part I: the significance of intracranial pressure monitoring. J Neurosurg 50:20–25, 1979
Masson F, , Thicoipe M, , Mokni T, , Aye P, , Erny P, & Dabadie P: Epidemiology of traumatic comas: a prospective populationbased study. Brain Inj 17:279–293, 2003
Mauritz W, , Steltzer H, , Bauer P, , Dolanski-Aghamanoukjan L, & Metnitz P: Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study. Intensive Care Med 34:1208–1215, 2008
McConnell KJ, , Newgard CD, , Mullins RJ, , Arthur M, & Hedges JR: Mortality benefit of transfer to level I versus level II trauma centers for head-injured patients. Health Serv Res 40:435–457, 2005
Miller JD, , Butterworth JF, , Gudeman SK, , Faulkner JE, , Choi SC, & Selhorst JB, et al.: Further experience in the management of severe head injury. J Neurosurg 54:289–299, 1981
Miller JD, , Gudeman SK, , Kishore PR, & Becker DP: CT scan, ICP and early neurological evaluation in the prognosis of severe head injury. Acta Neurochir Suppl (Wien) 28:86–88, 1979
Morris GF, , Bullock R, , Marshall SB, , Marmarou A, , Maas A, & Marshall LF: Failure of the competitive N-methyl-D-aspartate antagonist Selfotel (CGS 19755) in the treatment of severe head injury: results of two phase III clinical trials. The Selfotel Investigators. J Neurosurg 91:737–743, 1999
Murray GD: Use of an international data bank to compare outcome following severe head injury in different centres. Stat Med 5:103–112, 1986
Murray LS, , Teasdale GM, , Murray GD, , Jennett B, , Miller JD, & Pickard JD, et al.: Does prediction of outcome alter patient management?. Lancet 341:1487–1491, 1993
Murray LS, , Teasdale GM, , Murray GD, , Miller DJ, , Pickard JD, & Shaw MD: Head injuries in four British neurosurgical centres. Br J Neurosurg 13:564–569, 1999
Myburgh JA, , Cooper DJ, , Finfer SR, , Venkatesh B, , Jones D, & Higgins A, et al.: Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J Trauma 64:854–862, 2008
Narayan RK, , Greenberg RP, , Miller JD, , Enas GG, , Choi SC, & Kishore PR, et al.: Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg 54:751–762, 1981
Nathens AB, & Maier RV: The relationship between trauma center volume and outcome. Adv Surg 35:61–75, 2001
Nordstrom CH, , Messeter K, , Sundbarg G, & Wahlander S: Severe traumatic brain lesions in Sweden. Part I: Aspects of management in non-neurosurgical clinics. Brain Inj 3:247–265, 1989
Nordstrom CH, , Sundbarg G, , Messeter K, & Schalen W: Severe traumatic brain lesions in Sweden. Part 2: Impact of aggressive neurosurgical intensive care. Brain Inj 3:267–281, 1989
Odebode TO: Age related pattern and outcome of head injury in indigenous Africa. Niger J Clin Pract 11:265–269, 2008
Palmer S, , Bader MK, , Qureshi A, , Palmer J, , Shaver T, & Borzatta M, et al.: The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. J Trauma 50:657–664, 2001
Pazzaglia P, , Frank G, , Frank F, & Gaist G: Clinical course and prognosis of acute post-traumatic coma. J Neurol Neurosurg Psychiatry 38:149–154, 1975
Pentland B, , Hutton LS, & Jones PA: Late mortality after head injury. J Neurol Neurosurg Psychiatry 76:395–400, 2005
Pillai SV, , Kolluri VR, & Praharaj SS: Outcome prediction model for severe diffuse brain injuries: development and evaluation. Neurol India 51:345–349, 2003
Ramesh VG, , Thirumaran KP, & Raja MC: A new scale for prognostication in head injury. J Clin Neurosci 15:1110–1114, 2008
Rimel RW, , Jane JA, & Tyson GW: Emergency management of head injuries. Resuscitation 9:75–97, 1981
Rosner MJ, , Rosner SD, & Johnson AH: Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83:949–962, 1995
Rovlias A, & Kotsou S: Classification and regression tree for prediction of outcome after severe head injury using simple clinical and laboratory variables. J Neurotrauma 21:886–893, 2004
Rudnik A, , Wojtacha M, , Wencel T, & Bazowski P: The prognostic value of some clinical and diagnostic factors in traumatic intracranial haematoma. Acta Neurochir Suppl (Wien) 55:33–36, 1992
Ruff RM, , Marshall LF, , Crouch J, , Klauber MR, , Levin HS, & Barth J, et al.: Predictors of outcome following severe head trauma: follow-up data from the Traumatic Coma Data Bank. Brain Inj 7:101–111, 1993
Sahuquillo J: Does multimodality monitoring make a difference in neurocritical care?. Eur J Anaesthesiol Suppl 42:83–86, 2008
Saul TG, & Ducker TB: Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56:498–503, 1982
Schreiber MA, , Aoki N, , Scott BG, & Beck JR: Determinants of mortality in patients with severe blunt head injury. Arch Surg 137:285–290, 2002
Selassie AW, , McCarthy ML, , Ferguson PL, , Tian J, & Langlois JA: Risk of posthospitalization mortality among persons with traumatic brain injury, South Carolina 1999–2001. J Head Trauma Rehabil 20:257–269, 2005
Selladurai BM, , Jayakumar R, , Tan YY, & Low HC: Outcome prediction in early management of severe head injury: an experience in Malaysia. Br J Neurosurg 6:549–557, 1992
Servadei F, , Murray GD, , Penny K, , Teasdale GM, , Dearden M, & Iannotti F, et al.: The value of the “worst” computed tomographic scan in clinical studies of moderate and severe head injury. Neurosurgery 46:70–77, 2000
Shafi S, , Diaz-Arrastia R, , Madden C, & Gentilello L: Intracranial pressure monitoring in brain-injured patients is associated with worsening of survival. J Trauma 64:335–340, 2008
Signorini DF, , Andrews PJ, , Jones PA, , Wardlaw JM, & Miller JD: Predicting survival using simple clinical variables: a case study in traumatic brain injury. J Neurol Neurosurg Psychiatry 66:20–25, 1999
Soustiel JF, & Sviri GE: Monitoring of cerebral metabolism: nonischemic impairment of oxidative metabolism following severe traumatic brain injury. Neurol Res 29:654–660, 2007
Spain DA, , McIlvoy LH, , Fix SE, , Carrillo EH, , Boaz PW, & Harpring JE, et al.: Effect of a clinical pathway for severe traumatic brain injury on resource utilization. J Trauma 45:101–105, 1998
Stein SC, , Spettell C, , Young G, & Ross SE: Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 32:25–31, 1993
Stiefel MF, , Spiotta A, , Gracias VH, , Garuffe AM, , Guillamondegui O, & Maloney-Wilensky E, et al.: Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 103:805–811, 2005
Stocchetti N: Risk prevention, avoidable deaths and mortalitymorbidity reduction in head injury. Eur J Emerg Med 8:215–219, 2001
Stranjalis G, , Bouras T, , Korfias S, , Andrianakis I, , Pitaridis M, & Tsamandouraki K, et al.: Outcome in 1,000 head injury hospital admissions: the Athens head trauma registry. J Trauma 65:789–793, 2008
Struchen MA, , Hannay HJ, , Contant CF, & Robertson CS: The relation between acute physiological variables and outcome on the Glasgow Outcome Scale and Disability Rating Scale following severe traumatic brain injury. J Neurotrauma 18:115–125, 2001
Sundbarg G, , Norlund A, , Nordstrom CH, & Messeter K: Severe traumatic brain lesions in Sweden. Part 3: Economic aspects of aggressive neurosurgical intensive care. Brain Inj 3:283–293, 1989
Sweet RC, , Miller JD, , Lipper M, , Kishore PR, & Becker DP: Significance of bilateral abnormalities on the CT scan in patients with severe head injury. Neurosurgery 3:16–21, 1978
Teasdale G, & Jennett B: Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 34:45–55, 1976
Teasdale GM, , Pettigrew LE, , Wilson JT, , Murray G, & Jennett B: Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. J Neurotrauma 15:587–597, 1998
Thompson HJ, , Rivara FP, , Jurkovich GJ, , Wang J, , Nathens AB, & MacKenzie EJ: Evaluation of the effect of intensity of care on mortality after traumatic brain injury. Crit Care Med 36:282–290, 2008
Tiret L, , Hausherr E, , Thicoipe M, , Garros B, , Maurette P, & Castel JP, et al.: The epidemiology of head trauma in Aquitaine (France), 1986: a community-based study of hospital admissions and deaths. Int J Epidemiol 19:133–140, 1990
Tokutomi T, , Miyagi T, , Ogawa T, , Ono J, , Kawamata T, & Sakamoto T, et al.: Age-associated increases in poor outcomes after traumatic brain injury: a report from the Japan Neurotrauma Data Bank. J Neurotrauma 25:1407–1414, 2008
Toutant SM, , Klauber MR, , Marshall LF, , Toole BM, , Bowers SA, & Seelig JM, et al.: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:691–694, 1984
Udekwu P, , Kromhout-Schiro S, , Vaslef S, , Baker C, & Oller D: Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma 56:1084–1089, 2004
Valadka AB, , Gopinath SP, & Robertson CS: Midline shift after severe head injury: pathophysiologic implications. J Trauma 49:1–10, 2000
van Dongen KJ, , Braakman R, & Gelpke GJ: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:951–957, 1983
van Houwelingen HC, , Arends LR, & Stijnen T: Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21:589–624, 2002
Walder AD, , Yeoman PM, & Turnbull A: The abbreviated injury scale as a predictor of outcome of severe head injury. Intensive Care Med 21:606–609, 1995
Waxman K, , Sundine MJ, & Young RF: Is early prediction of outcome in severe head injury possible?. Arch Surg 126:1237–1242, 1991
Wintermark M, , van Melle G, , Schnyder P, , Revelly JP, , Porchet F, & Regli L, et al.: Admission perfusion CT: prognostic value in patients with severe head trauma. Radiology 232:211–220, 2004
Wu X, , Hu J, , Zhuo L, , Fu C, , Hui G, & Wang Y, et al.: Epidemiology of traumatic brain injury in eastern China, 2004: a prospective large case study. J Trauma 64:1313–1319, 2008
Xiao G, , Wei J, , Yan W, , Wang W, & Lu Z: Improved outcomes from the administration of progesterone for patients with acute severe traumatic brain injury: a randomized controlled trial. Crit Care 12:R61, 2008
Young B, , Rapp RP, , Norton JA, , Haack D, , Tibbs PA, & Bean JR: Early prediction of outcome in head-injured patients. J Neurosurg 54:300–303, 1981
All Time | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 1884 | 478 | 37 |
Full Text Views | 334 | 29 | 1 |
PDF Downloads | 219 | 28 | 2 |
EPUB Downloads | 0 | 0 | 0 |