Comparing Predicted vs Actual Mortality rates in Traumatic Brain Injury Patients before and after the Implementation of the Head Injury Protocol.

Head injuries or traumatic brain injuries is a major cause of death and disability worldwide with most of the burden (90%) in low and middle income countries. 1 The annual economic burden of TBI in the United States was approximately $60 billion in 2000.2 In Australia it is estimated to cost 4.8 billion per year. In the western world it is the 2nd most common cause of death after trauma. The incidence of death from head injury is approximately 7 per 100,000 and the severely brain-injured also have the highest mean length of stay and mean hospital costs. In the European Brain Injury Consortium (EBIC) study, 52% of head injuries were related to motor vehicle accidents. Worldwide the leading cause of TBI in the world is road traffic accidents, accounting for 40-50 percent of the hospitalizations for TBI.
The main concept that emerged from research is that all neurological damage from TBI does not occur at the moment of impact but rather evolves over the ensuing minutes, hours and days. This secondary brain injury can result in increased mortality and disability. Consequently, the early and appropriate management of TBI is critical to the survival of these patients.
Furthermore, improved outcome results when the secondary, delayed insults, resulting in reduced cerebral perfusion to the injured brain, are prevented or respond to treatment. The taskforce therefore developed "standards" of which there is "high degree of clinical certainty" with Level I evidence, "guidelines" of which there is "moderate degree of clinical certainty" with Level Il evidence and "options" of which there is "unclear clinical certainty" or Level Ill evidence.