Clinical Assessment and Diagnostic Procedures in Neurotrauma

Much has been learned over the past 20 years about traumatic brain injury (TBI). The surgical management of TBI has changed little during this period and continues to concentrate on early evacuation of significant space-occupying lesions. In contrast, there have been major changes in our approach to the critical care management of TBI during this period, and this is refl ected in the progressive and signifi cant reduction in severe TBI mortality from 50% to 10% over the last 30 years. This trend in reduced mortality and improved outcomes has, for the most part, been subsequent to the use of evidence-based critical care management protocols that emphasize assessment and monitoring. The main reasons for clinical assessment and monitoring neurocritical and neurotrauma patients could be summarized as follows: 1. detect the severity of trauma and recognize early neurological worsening before irreversible brain damage occurs; 2. individualise patient care decisions; 3. guide patient management; 4. monitor therapeutic response of some interventions and avoid any consequent adverse effects; 5. assist clinicians to understand the pathophysiology of complex disorders; 6. design and implement management protocols; 7. improve neurological outcome and quality of life in survivors of severe brain injuries