Moderate TBI (GCS 9 to 13) accounts for approximately 10 percent of patients with head injuries. Mortality rates for patients with isolated moderate TBI is less than 20 percent, but long-term disability is as high as 50 percent. Overall, 40 percent of moderate TBI patients have a positive CT scan and 8 percent require neurosurgical intervention.16 Approximately 10 percent of all moderate TBI patients will deteriorate due to secondary brain injury and progress to severe TBI.
Most patients with moderate TBI should be admitted because of the potential for deterioration ( Fig:i.247-4). Those with an initial GCS of 13 who return to normal, who remain intact after a 6-12h observation period, and who have a normal CT, can be discharged to family. Those with positive CT scans need neurosurgical consultation and admission to a monitored observation unit. If an institution has inadequate facilities to properly manage these patients, they should be transferred.
FIG. 247-4. Algorithm for the evaluation and treatment of moderate brain trauma.
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