Algorithm for the Management of Craniocerebral Injuries

Trauma remains the leading cause of death in young productive individuals globally. The poly-trauma is common in motor vehicular accidents, and therefore a team approach involving multiple medical specialties is mandatory for optimal outcomes. The team approach requires a planned, well-learned, and practiced algorithmic approach and skills in the management. An organized consistent algorithmic approach will lead to an optimal outcome for the majority of trauma victims. Head/brain injury, is the most commonly encountered traumatic injury seen in the emergency department. Currently, the incidence of severe head injury (SHI) is increasing and its management remains as challenging as ever, and although it is better than before, the clinical outcome is still with significant mortality, morbidity, and disability. Therefore, evidence-based medical practices highlight that prevention is the best option for primary brain injuries and modern neurointensive care unit (NICU) management has become a prerequisite for the prevention/treatment of secondary brain injuries. For the clinical management of head injury patients, the Glasgow Coma Scale (GCS) is widely used to categorize the initial severity of head injury. Therefore, the following three categories are defined as Minor (GCS-13–15 with an overall mortality rate of around 1–2%), Moderate (GCS-9–12 with a mortality rate of about 2–5%), and Severe (GCS-8 and less, with a mortality rate of 20–40%). The following steps are imperative in the management of head injury: (1) initial assessment and management of head injury patients at the site of trauma, (2) safe transportation to the trauma centers with neurosurgical facilities, (3) repeated primary surveys with resuscitation and stabilization of vital parameters, and (4) the secondary surveys with definitive care have become routine in modern neurosurgical centers due to Advanced Trauma Life Support (ATLS) guidelines currently practiced across the globe. Mortality and morbidity rates are improving but still are very significantly high. The main objectives of modern NICU include normalization of respiratory and cardiovascular functionality, controlled ventilation, neuro-imaging of the head, intracranial pressure monitoring, cerebral protection, aggressive surgical therapy for the significant posttraumatic intracranial mass lesions responsible for high intracranial pressure, and supportive services. With these efforts, there is a downward trend in overall trauma-related mortality (about 10–30%) and morbidity (10–50%) and disabilities (50–60%). These figures suggest that there is still a long way to go to achieve satisfactory outcomes. We are presenting here the algorithmic management of head injury as is currently practiced.