Traumatismo encefalocraneano moderado: un nuevo enfoque clínico para un término inadecuado

Abstract

Moderated TBI (mTBI) is a very heterogeneous group of patients but its mortality is relatively high. For this reason, the term moderated should be replaced by “potencially severe TBI” (psTBI). Outcome depends of prognostic factors that should be correctly considered at the initial hospital evaluation: age, GCS, GCSmotor, Marshall CT classification and type of brain injury as brain contusions or tASH. All these factors are strongly related with in-hospital patient evolution, mortality, outcome and neuropsycological sequels, that are frecuently underrated. In psTBI, we can distinguish 2 groups of patients: those with GCS 11-13 initial, and the GCS 9 -10 patients who are the high risk group for adverse clinical evolution, specially if is associated to Marshall CT category III and IV. This subgroup of patients should be considered as Severe TBI from the admission. An author’s group designed a new categorization using GCS and Marshall Scale creating a traffic light chart that helps to recognize patients with very high risk for neuroworsening. In the neurocritical care, hypotension and hypoxia must be avoided all the time, ocupying mass neurosurgery has to be done early, physiological variables need intensive care and multimodality neuromonitoring in the high risk subgroup should be considered. All these measures will allow improving outcome and decreasing mortality of patients with a not devastating primary brain injury.