🧠 Traumatic Brain Injury (TBI) Grading and Tiered Management
UseSeverity grading and tiered management of traumatic brain injury (BTF).
SourceCarney N, et al. Brain Trauma Foundation Guidelines for the Management of Severe TBI, 4th ed. Neuro…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Mild TBI mostly needs observation with CT by Canadian/New Orleans rules; beware delayed hemorrhage and anticoagulated/antiplatelet patients.
When to use
Severity grading and tiered management of traumatic brain injury (BTF).
How it works
GCS 13–15 mild, 9–12 moderate, ≤ 8 severe. ICP-monitoring indication [pending update]. Target ICP [pending update]to start lowering, CPP [pending update]. Tiers: sedation/positioning/ventilation → osmotherapy/CSF drainage/mild hyperventilation → barbiturates/craniectomy.
Key points
- Mild TBI mostly needs observation with CT by Canadian/New Orleans rules; beware delayed hemorrhage and anticoagulated/antiplatelet patients.
- Tier-1 measures (airway/analgesia-sedation, head-up 30°, normoventilation, CPP maintenance, treat fever/seizures) come before escalation.
- Tier-2 osmotherapy (mannitol 0.25–1 g/kg or hypertonic saline), CSF drainage and mild hyperventilation (PaCO₂ 32–35) precede refractory measures.
- Avoid hypotension (SBP < 90) and hypoxia throughout — both worsen secondary injury.
References
- [Guideline / primary source]Carney N, et al. Brain Trauma Foundation Guidelines for the Management of Severe TBI, 4th ed. Neurosurgery 2017
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Post-resuscitation GCS | 3 |
|---|---|
| Head CT | Abnormal (hematoma/contusion/edema/cisternal compression, etc.) |
→TBI severitySevere (GCS ≤ 8)
- Severity：GCS 3 → Severe (GCS ≤ 8)
- ICP-monitoring indication：ICP-monitoring indication [Pending update]
- Targets：Start ICP-lowering when ICP [pending update]mmHg; maintain CPP [pending update] mmHg (see the CPP tool)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Traumatic Brain Injury (TBI) Grading and Tiered Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Traumatic Brain Injury (TBI) Grading and Tiered Management upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Traumatic Brain Injury (TBI) Grading and Tiered Management calculated in practice? Can you show a worked example?
- Inputs: Post-resuscitation GCS 3, Head CT Abnormal (hematoma/contusion/edema/cisternal compression, etc.) → Result: TBI severity Severe (GCS ≤ 8)（Severity: GCS 3 → Severe (GCS ≤ 8), ICP-monitoring indication: ICP-monitoring indication [Pending update], Targets: Start ICP-lowering when ICP [pending update]mmHg; maintain CPP [pending update] mmHg (see the CPP tool)）