CLINICAL REVIEW Prehospital management of severe traumatic brain injury

Traumatic brain injury is a substantial cause ofmorbidity and mortality in the UK. An estimated 11 000 people per year sustain a severe traumatic brain injury, mostly between ages 15 and 29 years. Patients with severe traumatic brain injury have a high mortality rate (30-50%) and many survivors will have persistent severe neurological disability. Prompt identification and appropriate early management of traumatic brain injury is essential to optimise outcome, however, few guidelines are available for clinicians on management in the challenging prehospital environment. The 2007 report by the national enquiry into patient outcome and death on the provision of trauma services in the UK highlighted concerns about prehospital management of airways and ventilation in 15% of patients with severe head injuries. Doctors from various hospital specialties or general practice may be involved in providing prehospital care, so this review aims to provide a generic overview of available evidence on management of severe traumatic brain injury in adults in this environment.