Acute therapy of severe traumatic brain injury

Incidence and prognosis. The incidence of traumatic brain injury (TBI) in Germany is approximately 250,000 cases per year of which approximately 10,000 are classified as severe and despite sophisticated medical knowledge and advanced technical possibilities approximately 2,750 of these patients die from TBI. Therapy. The treatment of severe TBI is aimed at minimizing secondary damage to the injured brain for which the course is already set at the scene of the incident. Transport of TBI patients to a suitable neurosurgical center should be realized as soon as possible in order to carry out the necessary computed tomography (CT) scan and suitable targeted treatment immediately after initial diagnosis. The faster the treatment of a space-occupying primary injury is, the lower the degree of associated secondary brain injury which is very relevant for the overall prognosis. In addition continuous brain pressure monitoring with the possibility of immediate therapeutic intervention in an intensive care unit is an important prerequisite for improving the outcome of severe TBI. In cases of refractory increased intracranial pressure the indications for early decompressive craniectomy should be generously applied.