Severe TBI (GCS <9) accounts for approximately 10 percent of all emergency department patients with TBI. The mortality of severe TBI approaches 40 percent with deaths usually occurring within 48 h. Long-term disability is common, with less than 10 percent of patients making even a moderate recovery. The management of patients with severe TBI has three primary goals: to identify other life-threatening injuries, to prevent further secondary brain injury, and to identify treatable mass lesions. Management decisions are delineated in the algorithm, (Fig 247-5).
FIG. 247-5. Algorithm for the evaluation and treatment of severe brain trauma.
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