Skip to main content Accessibility help
  • Print publication year: 2008
  • Online publication date: January 2010

11 - Head Trauma – Anesthesia Considerations and Management

    • By Paul Tenenbein, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington, M. Sean Kincaid, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington, Arthur M. Lam, Department of Anesthesiology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Publisher: Cambridge University Press
  • DOI:
  • pp 172-186



Review the pathophysiology of traumatic brain injury.

Summarize the systemic manifestations of acute traumatic brain injury.

Review the current guidelines regarding management of traumatic brain injury.

Discuss the anesthetic management of traumatic brain injury and the potential complications.


Traumatic brain injury (TBI) imposes a significant burden on society, the presence of which is the primary determinant in quality of outcome following trauma [1]. With respect to age, it occurs in a bimodal fashion. Young persons between 15 and 24 years suffer head injuries in motor vehicles and violence, especially in association with alcohol use. Older persons, particularly those older than 75 years, suffer from an increased frequency of falls leading to head injury. It is estimated that 1.6 million head injuries occur annually in the United States with 250,000 patients requiring hospitalization [2, 3]. The results of these injuries include 60,000 deaths and 70,000–90,000 permanent neurologic disabilities [2, 4]. It is estimated that $100 billion is spent annually in the United States alone providing care for these individuals. Primary prevention is essential to decrease the burden of this problem. But for those who do sustain TBI, there is much we can do to provide the best possible care for these patients. Although the Brain Trauma Foundation has provided guidelines for the management of severe traumatic brain injury (, there are still many institutional differences in the care these patients receive, potentially affecting outcome [5].

Chesnut, RM.Care of central nervous system injuries. Surg Clin N Am 2007;87(1):119–56.
Guerrero, JL, Thurman, DJ, Sniezek, JE.Emergency department visits associated with traumatic brain injury: United States, 1995–1996. Brain Inj 2000;14(2):181–6.
Thurman, D, Guerrero, J.Trends in hospitalization associated with traumatic brain injury. JAMA 1999;282(10):954–7.
Sosin, DM, Sniezek, JE, Waxweiler, RJ. Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure. JAMA 1995;273(22):1778–80.
Bulger, EM, Nathens, AB, Rivara, FP, et al. Management of severe head injury: Institutional variations in care and effect on outcome. Crit Care Med 2002;30(8):1870–6.
Foulkes, M, Eisenberg, H, Jane, J.The Traumatic Coma Data Bank: Design, methods, and baseline characterisitics. J Neurosurg 1991;75(Suppl):S8.
Mendelow, AD, Teasdale, G, Jennett, B, et al. Risks of intracranial haematoma in head injured adults. Br Med J (Clin Res Ed) 1983;287(6400):1173–6.
Heary, RF, Hunt, CD, Kriger, AJ, et al. Nonsurgical treatment of compound depressed skull fractures. J Trauma 1993;35(3): 441–7.
Gopinath, SP, Cormio, M, Ziegler, J, et al. Intraoperative jugular desaturation during surgery for traumatic intracranial hematomas. Anesth Analg 1996;83(5):1014–21.
Schroder, ML, Muizelaar, JP, Kuta, AJ.Documented reversal of global ischemia immediately after removal of an acute subdural hematoma. Report of two cases. J Neurosurg 1994;80(2):324–7.
Massaro, F, Lanotte, M, Faccani, G, et al. One hundred and twenty-seven cases of acute subdural haematoma operated on. Correlation between CT scan findings and outcome. Acta Neurochir (Wien) 1996;138(2):185–91.
Zumkeller, M, Behrmann, R, Heissler, HE, et al. Computed tomographic criteria and survival rate for patients with acute subdural hematoma. Neurosurgery 1996;39(4):708–12; discussion 712–3.
Seelig, JM, Becker, DP, Miler, JD, et al. Traumatic acute subdural hematoma: Major mortality reduction in comatose patients treated within four hours. N Engl J Med 1981;304(25):1511–8.
Servadei, F.Prognostic factors in severely head injured adult patients with epidural haematoma's. Acta Neurochir (Wien) 1997;139(4):273–8.
Jamieson, KG, Yelland, JD.Extradural hematoma. Report of 167 cases. J Neurosurg 1968;29(1):13–23.
Chen, TY, Wong, CW, Chang, CN, et al. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery 1993;32(2):176–9; discussion 179.
Wong, CW.The CT criteria for conservative treatment – but under close clinical observation – of posterior fossa epidural haematomas. Acta Neurochir (Wien) 1994;126(2–4):124–7.
Clifton, GL, Grossman, RG, Makela, ME, et al. Neurological course and correlated computerized tomography findings after severe closed head injury. J Neurosurg 1980;52(5):611–24.
Choksey, M, Crockard, HA, Sandilands, M.Acute traumatic intracerebral haematomas: Determinants of outcome in a retrospective series of 202 cases. Br J Neurosurg 1993;7(6):611–22.
Mayer, SA, Brun, NC, Begtrup, K, et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2005;352(8):777–85.
Schroder, ML, Muizelaar, JP, Bullock, MR, et al. Focal ischemia due to traumatic contusions documented by stable xenon-CT and ultrastructural studies. J Neurosurg 1995;82(6):966–71.
Steiner, , Coles, JP, Johnston, AJ, et al. Responses of posttraumatic pericontusional cerebral blood flow and blood volume to an increase in cerebral perfusion pressure. J Cereb Blood Flow Metab 2003;23(11):1371–7.
Liu, AY, Maldjian, JA, Bagley, LJ, et al. Traumatic brain injury: Diffusion-weighted MR imaging findings. AJNR Am J Neuroradiol 1999;20(9):1636–41.
Smith, DH, Nonaka, M, Miller, R, et al. Immediate coma following inertial brain injury dependent on axonal damage in the brainstem. J Neurosurg 2000;93(2):315–22.
Gennarelli, TA, Spielman, GM, Langfitt, TW, et al. Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg 1982;56(1):26–32.
Chesnut, RM, Marshall, LF, Klauber, MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993;34(2):216–22.
Doppenberg, EM, Choi, SC, Bullock, R.Clinical trials in traumatic brain injury: Lessons for the future. J Neurosurg Anesthesiol 2004;16(1):87–94.
Bulger, EM, Copass, MK, Sabath, DR, et al. The use of neuromuscular blocking agents to facilitate prehospital intubation does not impair outcome after traumatic brain injury. J Trauma 2005;58(4):718–23; discussion 723–4.
Winchell, RJ, Hoyt, DB.Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma Research and Education Foundation of San Diego. Arch Surg 1997;132(6):592–7.
Davis, DP, Fakhry, SM, Wang, HE, et al. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma 2003;54(3): 444–53.
Michael, DB, Guyot, DR, Darmody, WR.Coincidence of head and cervical spine injury. J Neurotrauma 1989;6(3):177–89.
Holly, LT, Kelly, DF, Counelis, GJ, et al. Cervical spine trauma associated with moderate and severe head injury: Incidence, risk factors, and injury characteristics. J Neurosurg 2002;96(3 Suppl):285–91.
Lennarson, PJ, Smith, D, Todd, MM, et al. Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization. J Neurosurg 2000;92(2 Suppl):201–6.
Hastings, RH, Wood, PR.Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology 1994;80(4):825–31.
Donaldson, WF III, Towers, JD, Doctor, A, et al. A methodology to evaluate motion of the unstable spine during intubation techniques. Spine 1993;18(14):2020–3.
Butler, J, Sen, A.Best evidence topic report. Cricoid pressure in emergency rapid sequence induction. Emerg Med J 2005;22(11):815–6.
Albrecht, RF, Miletich, DJ, Rosenberg, R, et al. Cerebral blood flow and metabolic changes from induction to onset of anesthesia with halothane or pentobarbital. Anesthesiology 1977;47(3):252–6.
Unni, VK, Johnston, RA, Young, HS, et al. Prevention of intracranial hypertension during laryngoscopy and endotracheal intubation. Use of a second dose of thiopentone. Br J Anaesth 1984;56(11):1219–23.
Eckstein, JW, Hamilton, WK, McCammond, JM. The effect of thiopental on peripheral venous tone. Anesthesiology 1961;22:525–8.
Renou, AM, Vernhiet, J, Macrez, P, et al. Cerebral blood flow and metabolism during etomidate anaesthesia in man. Br J Anaesth 1978;50(10):1047–51.
Gooding, JM, Corssen, G.Effect of etomidate on the cardiovascular system. Anesth Analg 1977;56(5):717–9.
Bedford, RF, Persing, JA, Pobereskin, L, et al. Lidocaine or thiopental for rapid control of intracranial hypertension?Anesth Analg 1980;59(6):435–7.
White, PF, Schlobohm, RM, Pitts, LH, et al. A randomized study of drugs for preventing increases in intracranial pressure during endotracheal suctioning. Anesthesiology 1982;57(3):242–4.
Cottrell, JE, et al. Intracranial and hemodynamic changes after succinylcholine administration in cats. Anesth Analg 1983;62(11):1006–9.
Kovarik, WD, Mayberg, TS, Lam, AM, et al. Succinylcholine does not change intracranial pressure, cerebral blood flow velocity, or the electroencephalogram in patients with neurologic injury. Anesth Analg 1994;78(3):469–73.
Contant, CF, Valadka, AB, Gopinath, SP, et al. Adult respiratory distress syndrome: A complication of induced hypertension after severe head injury. J Neurosurg 2001;95(4):560–8.
Teasdale, G, Jennett, B.Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2(7872):81–4.
Teasdale, G, Knill-Jones R, , Sande, J.Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry 1978;41(7):603–10.
Klauber, MR, Marshall, LF, Barrett-Connor E, , et al. Prospective study of patients hospitalized with head injury in San Diego County, 1978. Neurosurgery 1981;9(3):236–41.
Jennett, B, Teasdale, G, Braakman, R, et al. Prognosis of patients with severe head injury. Neurosurgery 1979;4(4):283–9.
Marshall, LF, Marshall, SB, Klauber, MR, et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 1992;9(Suppl 1):S287–92.
The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Guidelines for cerebral perfusion pressure. J Neurotrauma 2007;24:S59–S64.
The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring. J Neurotrauma 2007;24:S37–S44.
Narayan, RK, Kishore, PR, Becker, DP, et al. Intracranial pressure: To monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 1982;56(5):650–9.
Lobato, RD, Gomez, PA, Alday, R, et al. Sequential computerized tomography changes and related final outcome in severe head injury patients. Acta Neurochir (Wien) 1997;139(5):385–91.
Stein, SC, Spettell, C, Young, G, et al. Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 1993;32(1):25–30; discussion 30–1.
Lundberg, N.Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand 1960;36(Suppl 149):1–193.
Rosner, MJ, Becker, DP.Origin and evolution of plateau waves. Experimental observations and a theoretical model. J Neurosurg 1984;60(2):312–24.
Cormio, M, Valadka, AB, Robertson, CS.Elevated jugular venous oxygen saturation after severe head injury. J Neurosurg 1999;90(1):9–15.
Gopinath, SP, Robertson, CS, Contant, CF, et al. Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry 1994;57(6):717–23.
Doppenberg, EM, Zauner, A, Bullock, R, et al. Correlations between brain tissue oxygen tension, carbon dioxide tension, pH, and cerebral blood flow – a better way of monitoring the severely injured brain?Surg Neurol 1998;49(6):650–4.
Zauner, A, Doppenberg, EM, Woodward, JJ, et al. Continuous monitoring of cerebral substrate delivery and clearance: Initial experience in 24 patients with severe acute brain injuries. Neurosurgery 1997;41(5):1082–91.
Marmarou, A, Anderson, RL, Ward, JD, et al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991;75(Suppl):S59–66.
Juul, N, Morris, GF, Marshall, SB, et al. influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg 2000;92(1):1–6.
Miller, JD, Becker, DP, Ward, JD, et al. Significance of intracranial hypertension in severe head injury. J Neurosurg 1977;47(4): 503–16.
Rosner, MJ, Rosner, SD, Johnson, AH.Cerebral perfusion pressure: Management protocol and clinical results. J Neurosurg 1995;83:949–62.
Eisenberg, HM, Frankowski, RF, Contant, CF, et al. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988;69(1):15–23.
Robertson, CS, Valadka, AB, Hannay, HJ, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med 1999;27(10):2086–95.
Wise, BL, Chater, N.The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebro-spinal-fluid pressure. J Neurosurg 1962;19:1038–43.
Muizelaar, JP, Wei, EP, Kontos, HA, Becker, DP.Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 1983;59(5):822–8.
Roberts, PA, Pollay, M, Engles, C, et al. Effect on intracranial pressure of furosemide combined with varying doses and administration rates of mannitol. J Neurosurg 1987;66:440–6.
Battison, C, Andrews, PJ, Graham, C, Petty, T.Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med 2005;33:196–202.
Coles, JP, Minhas, PS, Fryer, TD, et al. Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates. Crit Care Med 2002;30:1950–9.
Sheinberg, M, Kanter, MJ, Robertson, CS, et al. Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg 1992;76:212–7.
Nekeludov, M, Antovic, J, Bredbacka, S, Blomback, M.Coagulation abnormalities associated with severe isolated traumatic brain injury: Cerebral arterio-venous differences in coagulation and inflammatory markers. J Neurotrauma 2007;24:174–80.
Vavilala, MS, Dunbar, PJ, Rivara, FP, Lam, AM.Coagulopathy predicts poor outcome following head injury in children less than 16 years of age. J Neurosurg Anesthesiol 2001;13:13–8.
Lam, AM, Winn, HR, Cullen, BF, Sundling, N.Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg 1991;75:545–51.
Jeremitsky, E, Omert, , Dunham, CM, et al. A. The impact of hyperglycemia on patients with severe brain injury. J Trauma 2005;58:47–50.
Berghe, G, Schoonheydt, K, Becx, P, et al. Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology 2005;26(64):1348–53.
Bergsneider, M, Hovda, DA, Shalmon, E, et al. Cerebral hyperglycolysis following severe traumatic brain injury in humans: A positron emission tomography study. J Neurosurg 1997;86:241–51.
SAFE Study Investigators: Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med 2007;357(9):874–84.
Wiedermann, CJ.Complications of hydroxyethyl starch in acute ischemic stroke and other brain injuries. Pathophysiol Haemost Thromb 2003;33:121–6.
Clifton, GL, Miller, ER, Choi, SC, et al. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001;344:556–63.
Clifton, GL, Miller, ER, Choi, SC, et al. Hypothermia on admission in patients with severe brain injury. J Neurotrauma 2002;19:293–301.
Clifton, GL.Is keeping cool still hot? An update on hypothermia in brain injury. Curr Opin Crit Care 2004;10:116–9.
Polderman, KH.Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality. Part 2: Practical aspects and side effects. Intensive Care Med 2004;30:757–69.
Adelson, PD, Ragheb, J, Kanev, P, et al. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery 2005;56:740–54.
Jiang, J, Yu, M, Zhu, C.Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg 2000;93:546–9.
Vasile, B, Rasulo, F, Candiani, A, Latronico, N.The pathophysiology of propofol infusion syndrome: A simple name for a complex syndrome. Intensive Care Med 2003;29:1417–25.
Cremer, OL, Moons, KG, Bouman, EA, Kruijswijk, JE, Smet, AM, Kalkman, CJ.Long-term propofol infusion and cardiac failure in adult head-injured patients. Lancet 2001;13(357):117–8.
Edwards, P, Arango, M, Balica, L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 2005;10(365):1957–9.
Hutchinson, PJ, Kirkpatrick, PJ.Decompressive craniectomy in head injury. Curr Opin Crit Care 2004;10:101–4
Sahuquillo, J, Arikan, F.Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev 2006(1):CD003983.
Jaeger, M, Soehle, M, Meixensberger, J.Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry 2003;74(4):513–5.
Stiefel, MF, Heuer, GG, Smith, MJ, et al. Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg 2004;101(2):241–7.
Aarabi, B, Hesdorffer, DC, Ahn, ES, et al. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 2006;104(4):469–79.
Muizelaar, JP, Marmarou, A, Ward, JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: A randomized clinical trial. J Neurosurg 1991;75(5):731–9.
Cold, GE.Does acute hyperventilation provoke cerebral oligaemia in comatose patients after acute head injury?Acta Neurochir (Wien) 1989;96(3–4):100–6.
The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Hyperventilation. J Neurotrauma 2007;24:S87–S90.
Oshima, T, Karasawa, F, Satoh, T.Effects of propofol on cerebral blood flow and the metabolic rate of oxygen in humans. Acta Anaesthesiol Scand 2002;46(7):831–5.
Oertel, M, Kelly, DF, Lee, JH, et al. Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury. J Neurosurg 2002;97(5):1045–53.
Warner, DS, Takaoka, S, Wu, B, et al. Electroencephalographic burst suppression is not required to elicit maximal neuroprotection from pentobarbital in a rat model of focal cerebral ischemia. Anesthesiology 1996;84(6):1475–84.
Kochs, E, Hoffman, WE, Werner, C, et al. The effects of propofol on brain electrical activity, neurologic outcome, and neuronal damage following incomplete ischemia in rats. Anesthesiology 1992;76(2):245–52.
Johnston, AJ, Steiner, , Chatfield, DA, et al. Effects of propofol on cerebral oxygenation and metabolism after head injury. Br J Anaesth 2003;91(6):781–6.
Strebel, S, Lam, AM, Matta, B, et al. Dynamic and static cerebral autoregulation during isoflurane, desflurane, and propofol anesthesia. Anesthesiology 1995;83(1):66–76.
Kawaguchi, M, Kimbro, JR, Drummond, JC, et al. Isoflurane delays but does not prevent cerebral infarction in rats subjected to focal ischemia. Anesthesiology 2000;92(5):1335–42.
Sarraf-Yazdi S, , Sheng, H, Miura, Y, et al. Relative neuroprotective effects of dizocilpine and isoflurane during focal cerebral ischemia in the rat. Anesth Analg 1998;87(1):72–8.
Oshima, T, Karasawa, F, Okazaki, Y, et al. Effects of sevoflurane on cerebral blood flow and cerebral metabolic rate of oxygen in human beings: A comparison with isoflurane. Eur J Anaesthesiol 2003;20(7):543–7.
Matta, BF, Heath, KJ, Tipping, K, et al. Direct cerebral vasodilatory effects of sevoflurane and isoflurane. Anesthesiology 1999;91(3):677–80.
Adams, RW, Cucchiara, RF, Gronert, GA, et al. Isoflurane and cerebrospinal fluid pressure in neurosurgical patients. Anesthesiology 1981;54(2):97–9.
Grosslight, K, Foster, R, Colohan, AR, et al. Isoflurane for neuroanesthesia: Risk factors for increases in intracranial pressure. Anesthesiology 1985;63(5):533–6.
Scheller, MS, Todd, MM, Drummond, JC, et al. The intracranial pressure effects of isoflurane and halothane administered following cryogenic brain injury in rabbits. Anesthesiology 1987;67(4):507–12.
Summors, AC, Gupta, AK, Matta, BF.Dynamic cerebral autoregulation during sevoflurane anesthesia: A comparison with isoflurane. Anesth Analg 1999;88(2):341–5.
Pietropaoli, JA, Rogers, FB, Shackford, SR, et al. The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries. J Trauma 1992;33(3):403–7.
Pelligrino, DA, Miletich, DJ, Hoffman, WE, et al. Nitrous oxide markedly increases cerebral cortical metabolic rate and blood flow in the goat. Anesthesiology 1984;60(5):405–12.
Matta, BF, Lam, AM.Nitrous oxide increases cerebral blood flow velocity during pharmacologically induced EEG silence in humans. J Neurosurg Anesthesiol 1995;7(2):89–93.
Moss, E, McDowall, DG. I.c.p. increases with 50% nitrous oxide in oxygen in severe head injuries during controlled ventilation. Br J Anaesth 1979;51(8):757–61.
Kawaguchi, M, Sakamoto, T, Ohnishi, H, et al. Preoperative predictors of reduction in arterial blood pressure following dural opening during surgical evacuation of acute subdural hematoma. J Neurosurg Anesthesiol 1996;8(2):117–22.
Wijdicks, EF.The diagnosis of brain death. N Engl J Med 2001;344(16):1215–21.
Grotz, MR, Giannondis, PV, Paper, HC, et al. Traumatic brain injury and stabilisation of long bone fractures: An update. Injury 2004;35(11):1077–86.
Hlatky, R, Furuya, Y, Valadka, AB, et al. Dynamic autoregulatory response after severe head injury. J Neurosurg 2002;97(5):1054–61.
Chesnut, RM.Management of brain and spine injuries. Crit Care Clin 2004;20(1):25–55.
Marshall, LF, Maas, AI, Marshall, SB, et al. A multicenter trial on the efficacy of using tirilazad mesylate in cases of head injury. J Neurosurg 1998;89(4):519–25.
Murray, GD, Teasdale, GM, Braakman, R, et al. The European Brain Injury Consortium survey of head injuries. Acta Neurochir (Wien) 1999;141(3):223–36.
Andrews, PJ, Sleeman, DH, Statham, PF, et al. Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: A comparison between decision tree analysis and logistic regression. J Neurosurg 2002;97(2):326–36.
Choi, SC, Muizelaar, JP, Barnes, TY, et al. Prediction tree for severely head-injured patients. J Neurosurg 1991;75(2):251–5.
Signorini, DF, Andrews, PJ, Jones, PA, et al. Predicting survival using simple clinical variables: A case study in traumatic brain injury. J Neurol Neurosurg Psychiatry 1999;66(1):20–5.
Hukkelhoven, CW, Steyerberg, EW, Habbema, JD, et al. Predicting outcome after traumatic brain injury: Development and validation of a prognostic score based on admission characteristics. J Neurotrauma 2005;22(10):1025–39.