New TBI Care Guidelines Released by ACS

The American College of Surgeons (ACS) has published a revised set of practical recommendations for the care of people with traumatic brain injury (TBI), with the aim of improving treatment and patient outcomes. The Best Practices Guidelines for the Management of Traumatic Brain Injury, which were originally published in 2015, are now updated to include new developments and considerations in TBI care, including advancements in neuroimaging techniques, blood-based biomarkers, pharmacologic management, rehabilitation, and postacute care.

The revisions were developed through consensus opinion and a review of evidence conducted by an international, multidisciplinary panel of experts chaired by Geoffrey T. Manley, MD, PhD of the University of California, San Francisco. Specialties represented among members of the panel include nursing, radiology, anesthesiology, neurosurgery, emergency medicine, pediatric medicine, rehabilitation medicine, and pharmacology. Dedicated information for managing pediatric and older adult patients with suspected TBI also are included in the recommendations.

The following new topics are covered in the revised guidelines:

• Imaging: Guidance is provided on when to use CT scans and MRI to evaluate TBI in pediatric and adult patients, and the authors note that a negative head CT does not rule out TBI.
• Blood Based Biomarkers: The recommendations include guidance on the use of blood-based biomarkers such as glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein (S100B) for ruling out the need for head CT and predicting patient recovery at 6 months postinjury.
• Pharmacotherapy: The authors discuss the use of antiseizure medications (ASMs) to avoid posttraumatic seizures (PTS), strategies to prevent stroke and bleeding via antiplatelet and anticoagulant therapy, and other pharmacologic interventions.
• Rehabilitation: The guidelines state that collaboration between trauma and rehabilitation experts is necessary to promote a positive recovery trajectory.
• Postacute Care: The authors have added new sections with considerations for patients with a Glasgow Coma Scale (GCS) score of 13 to 15, outcome assessment and quality improvement, and TBI education and follow-up.

The full set of guidelines is available for free online as a resource for healthcare providers:  https://www.facs.org/media/vgfgjpfk/best-practices-guidelines-traumatic-brain-injury.pdf.