Prehospital Guidelines for the Management of Traumatic Brain Injury – 3rd Edition

Figures & data

Figure 1. Fatality rate for all causes of traumatic brain injury (TBI). Source: Brown et al. (3); Used with permission.

Figure 2. Rural vs. urban traumatic brain injury (TBI) fatality rates. Dark red areas indicate higher age-adjusted fatality rates from TBI. Black-lined areas indicate rural regions. Source: Brown et al. (3). Used with permission.

Table 1. Categories and topics included in this update.

Assessment	Treatment	Diagnosis
Oxygenation, blood pressure, and temperature	Airway, ventilation, and oxygenation	Decision making within the EMS System: Dispatch and destination
Glasgow Coma Scale Score	Fluid resuscitation	Decision making within the EMS System: On-scene
Pupil examination	Hyperventilation and hyperosmolar Therapy	Decision making within the EMS System: Transportation

Abbreviations: EMS, emergency medical services.

Table 2. Comparison of Pediatric GCS with GCS.

Glasgow Coma Scale		Pediatric Glasgow Coma Scale
Eye opening		Eye opening
- Spontaneous	4	- Spontaneous	4
- Speech	3	- Speech	3
- Pain	2	- Pain	2
- None	1	- None	1
Verbal response		Verbal response
- Oriented	5	- Coos, babbles	5
- Confused	4	- Irritable cries	4
- Inappropriate	3	- Cries to pain	3
- Incomprehensible	2	- Moans to pain	2
- None	1	- None	1
Motor response		Motor response
- Obey command	6	- Normal spontaneous movement.	6
- Localize pain	5	- Withdraws to touch	5
- Flexor withdrawal	4	- Withdraws to pain	4
- Flexor posturing	3	- Abnormal flexion	3
- Extensor posturing	2	- Abnormal extension	2
- None	1	- None	1

Abbreviations: GCS, Glasgow Coma Scale.

Figure 3. Stepwise execution of prehospital decision-making in the care of a patient with head injury.

Figure 4. Prehospital algorithm for evaluation and management of patients with suspicion for moderate to severe TBI.

Brown JB, Kheng M, Carney NA, Rubiano AM, Puyana JC. Geographical disparity and traumatic brain injury in America: rural areas suffer poorer outcomes. J Neurosci Rural Pract. 2019;10(1):10–5.

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