RECOMMENDATIONS

Document Overview

Design and created by Guideline Central in participation with the Brain Trauma Foundation.

Management of Severe Traumatic Brain Injury

Brain Trauma Foundation

Publication Date: Sep 20, 2016

Page Last Updated: May 22, 2026

BTF Level of Recommendations

Document Overview

Document Title: Management of Severe Traumatic Brain Injury

Authoring Society: Brain Trauma Foundation

Document Publication Date: Sep 20, 2016

Page Last Reviewed/Updated: May 22, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: braintrauma.org/coma/guidelines/severe-tbi

Source Citation: Nancy Carney, PhD, Annette M. Totten, PhD, Cindy O'Reilly, BS, Jamie S. Ullman, MD, Gregory W.J. Hawryluk, MD, PhD, Michael J. Bell, MD, Susan L. Bratton, MD, Randall Chesnut, MD, Odette A. Harris, MD, MPH, Niranjan Kissoon, MD, Andres M. Rubiano, MD, Lori Shutter, MD, Robert C. Tasker, MBBS, MD, Monica S. Vavilala, MD, Jack Wilberger, MD, David W. Wright, MD, Jamshid Ghajar, MD, PhD, Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition, Neurosurgery, Volume 80, Issue 1, January 2017, Pages 6–15, https://doi.org/10.1227/NEU.0000000000001432

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Scope: Assessment and Screening, Management, Treatment

Diseases/Conditions (MeSH): D000070642 - Brain Injuries, Traumatic

Keywords: Neurotrauma, Severe traumatic brain injury, TBI, coma

Inclusion Criteria: Female, Male, Adult, Older Adult

Health Care Settings: Emergency Care, Hospital, Operating and Recovery Room

Intended Users: Nurse, Nurse Practitioner, Paramedic/EMT, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 340

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Grade	Definition
Level I	Recommendations were based on a high-quality body of evidence.
Level IIA	Recommendations were based on a moderate-quality body of evidence.
Level IIB	Recommendations were based studies that provided direct evidence but were of overall low quality.
Level III	Recommendations were based on studies providing only indirect evidence.

Management of Severe Traumatic Brain Injury

RECOMMENDATIONS

Treatment

Decompressive craniectomy (DC)

Prophylactic hypothermia

Hyperosmolar therapy

Cerebrospinal fluid drainage

Ventilation therapies

Anesthetics, analgesics, and sedatives

Steroids

Nutrition

Infection prophylaxis

Deep vein thrombosis prophylaxis

Seizure prophylaxis

Monitoring

Intracranial pressure monitoring

Cerebral perfusion pressure monitoring

Advanced cerebral monitoring

Thresholds

Blood pressure thresholds

Intracranial pressure thresholds

Cerebral perfusion pressure thresholds

Advanced cerebral monitoring thresholds

BTF Level of Recommendations

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology