British Trauma Foundation

The Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Head Injury were the first clinical practice guidelines published by any surgical specialty. These guidelines, which were provided in 2007, have earned a reputation for rigor and have been widely adopted around the world. Implementation of these guidelines has been associated with a 50% reduction in mortality and reduced costs of patient care. Since the time of publication, these traumatic brain injury (TBI) guidelines have been expanded, refined, and made increasingly more rigorous in conjunction with new clinical evidence and evolving methodologic standards.^[25]

Planned changes to future TBI guidelines are intended to increase their utility and positive impact in an evolving medical landscape. Perhaps the greatest limitation of TBI guidelines is the lack of high-quality clinical research, as well as novel diagnostics and treatments, on which to based substantially new recommendations.^[25]

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Media Gallery

CT scan of an acute left-sided epidural hematoma. Note the typical convex or lens-shaped appearance. The hematoma takes this shape as the dura strips from the undersurface of the cranium, limited by the suture lines. A midline shift of the ventricular system is present. This hemorrhage requires immediate surgical evacuation.
Axial CT scan that demonstrates a large vertex, bifrontoparietal epidural hemorrhage (EDH). Air bubbles are within the hematoma.
CT bone window image of same patient in Media file 2 that demonstrates a large midline fracture.
Coronal CT scan reconstruction that further clarifies the thickness and mass effect associated with this vertex epidural hemorrhage (EDH).
Sagittal CT scan reconstruction that further defines the anterior-posterior extent of the vertex epidural hemorrhage (EDH).
CT image of a pre-adolescent male with a left posterior fossa epidural hemorrhage (EDH). Such hemorrhages need to be watched carefully, and the surgical team should have a low threshold for surgical intervention because this region has less room to accommodate mass lesions.
Bone window of the same patient as Media file 6 that reveals a diastasis (separation) of the left mastoid suture.

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Author

Jamie S Ullman, MD, FACS Professor, Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Director of Neurotrauma, Northwell Institute of Neurology and Neurosurgery, North Shore University Hospital

Jamie S Ullman, MD, FACS is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, Congress of Neurological Surgeons

Disclosure: Principal investigator on a clinical experience protocol for: Helius Medical.

Coauthor(s)

Anthony Sin, MD Clinical Fellow in Neurotrauma, Department of Neurosurgery, Mt Sinai Services, Elmhurst Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ryszard M Pluta, MD, PhD (Retired) Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences, Poland; (Retired) Clinical Staff Scientist, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH); (Retired) Fishbein Fellow, JAMA

Ryszard M Pluta, MD, PhD is a member of the following medical societies: Congress of Neurological Surgeons, Polish Society of Neurosurgeons

Disclosure: Nothing to disclose.

Chief Editor

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons, International Parkinson and Movement Disorder Society, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from Abbott Neuromodulation for consulting; Received Consulting Fee from ClearPoint Neuro.

Additional Contributors

Michael G Nosko, MD, PhD Associate Professor of Surgery, Chief, Division of Neurosurgery, Medical Director, Neuroscience Unit, Medical Director, Neurosurgical Intensive Care Unit, Director, Neurovascular Surgery, Rutgers Robert Wood Johnson Medical School

Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Congress of Neurological Surgeons, Canadian Neurological Sciences Federation, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Epidural Hematomas Guidelines

British Trauma Foundation

References

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