Management of Acute Traumatic Brain Injury in the Community Setting

Traumatic brain injury (TBI) may be managed clinically in the university or community setting. Traditional reviews regarding clinical management of TBI are often presented from a university viewpoint with the role of neurosurgery and surgery residents and attending staff well defined in the setting of a large, regional hospital. In contrast, community trauma centers are usually smaller and lack neurosurgery and surgical resident staff. In the community, an emergency department physician and/or a trauma surgeon first assesses acute trauma injury. Neurosurgery, orthopedic surgery, and critical care physicians are all utilized on a consultation basis. The overall general guidelines for clinical management of TBI are similar to those used in a university setting. However, the pathways to the end result differ, and this article details these pathways.