Traumatic Brain Injury

The emergency department (ED) clinician needs to be prepared to manage patients of all ages with traumatic brain injury (TBI). This review outlines key historical and physical examination findings on initial trauma evaluation and treatment of the severely head injured patient with a herniation syndrome. The most common lesions seen on cranial computed tomographic (CT) scanning are discussed. Since the most important decision in managing patients with milder forms of TBI is whether to perform brain imaging, the review includes an in-depth discussion of the history and evolution of CT decision rules, including the most commonly used rule in children. Given the aging population and increased use of anticoagulants, it is imperative to understand the current evidence available to best treat these patients. Finally, we may all be required to assess sport-related concussions in the ED or on the field. This review contains 6 figures, 10 tables, and 37 references. Key words: traumatic brain injury, concussion, subdural hematoma, subarachnoid hemorrhage, Canadian head CT rules, PECARN, mannitol, hypertonic saline