The Development of Best Practice Penetrating TBI Guidelines for Military and Civilian Patients

Penetrating traumatic brain injury (pTBI) is a devastating trauma that is lethal in a large percentage of those who suffer it. It is highly prevalent in military populations during war, and represents a signature injury pattern encountered during the conflicts in Iraq and Afghanistan. Guidelines that aide in the management of this condition were last published in 2001, and as such are outdated and in large part no longer applicable. These guidelines specifically do not reflect the advances seen in the management of blast-related penetrating brain injury. Healthcare providers charged with caring for patients with this wound would benefit from an organized guideline and treatment algorithm.

The goal of this study is to comprehensively review the body of published pTBI and blast-related pTBI literature, evaluate the quality of that literature, and use that review to create updated clinical practice guidelines and treatment algorithms that will guide treatment for those patients who survive. This will be accomplished by first utilizing the expertise and considerable experience of the Brain Trauma Foundation, the organization directly responsible for the creation of the 4th edition of the Traumatic Brain Injury Guidelines (largely focused on closed head injury) and the subsequent published treatment algorithm now widely used throughout the world. Military and civilian pTBI subject matter experts from around the world will then meet to create for widest dissemination the final knowledge products.

Every year 32,000 civilians will die in the United States from a firearms injury, and a large percentage of those deaths result from pTBI. For those who survive to reach hospital care, there is currently no consensus on standard treatment approach. While a more uniform approach to pTBI exists within the military, this approach has limited application in the civilian system. The guidelines and treatment algorithms generated from this proposal will inform civilian practice and military battlefield management, drive future study by identifying gaps in knowledge, and ultimately improve survival in this highly lethal injury mechanism.