The First 24 Hours after Severe Head Trauma

Severe traumatic brain injury (TBI) is defined by a Glasgow Coma Scale (GCS) score of 8 or less during the first post-trauma day. It is recognized as a devastating pathology in terms of mortality and morbidity. Long-term recovery is poor with only 10 to 20 % patients returning to work after 1 year [1, 2]. If all severe TBI patients are taken into account (including those deceased before arrival at hospital), one-year mortality ranges between 35 to 45 % [3–6]. Mortality is dramatic in the first days with more than 40 % of all deaths occurring within the first 24 hours [1, 6]. Numbers of studies have demonstrated the importance of the initial hours after severe head trauma. After trauma, physiologic mechanisms against ischemia in cerebral tissue are impaired and traumatized brain highly vulnerable to ischemic injuries [7]. And the more recent the trauma, the more the brain is vulnerable [8]. Moreover, ischemic injuries are frequent during the first post-traumatic hours, notably in cases of multiple trauma. These ischemic injuries, even for a few minutes, have a dramatic negative impact on long-term outcomes. Thus, amelioration of initial care should greatly improve outcome.