Executive summary of the Brain Trauma Foundation Guidelines for the Management of Penetrating Traumatic Brain Injury, Second Edition

BACKGROUND – New literature and military conflicts inspired the second edition of the Guidelines for the Management of Penetrating Traumatic Brain Injury (pTBI). In an effort to make the evidence-based guidelines more impactful to clinical practice, expert consensus and treatment algorithms were incorporated. METHODS – The published pTBI guidelines were reviewed, and an executive summary of the recommendations specifically relevant to trauma and critical care were created. These include resuscitation, imaging including screening for vascular injuries, critical care management (intracranial pressure, antibiotics, seizure prophylaxis, and thromboembolic prophylaxis), timing of surgery, surgical technique, management of vascular complications, and prognosis. RESULTS – A summary of the recommendations is provided including evidence-based guidelines (3 Level II, 10 Level III, and 15 Level IV) as well as expert consensus (Level C, 57 statements). Seven treatment algorithms are presented including a futility assessment tool. CONCLUSION – The pTBI guidelines are intended to be used to assist the clinical care of a patient with pTBI. The clinical questions are addressed with published evidence when available and supplemented with expert consensus to guide the clinician caring for a patient with pTBI from admission, including resuscitation and imaging, surgical intervention, postoperative care and monitoring, and future screening and follow-up.