🧠 Traumatic Brain Injury (TBI) Grading and Tiered Management
Grade TBI by GCS and, for severe TBI, give the ICP-monitoring indication and the tiered management plan. Instant, browser-side.
Traumatic Brain Injury (TBI) Grading and Tiered Management
Post-resuscitation GCS
Head CT
When to use
Severity grading and tiered management of traumatic brain injury (BTF).
How it works
GCS 13–15 mild, 9–12 moderate, ≤ 8 severe. Severe + abnormal CT → ICP monitoring recommended; severe + normal CT → monitor if ≥ 2 of (age > 40, decerebrate/decorticate posturing, SBP < 90). Target ICP > 22 to start lowering, CPP 60–70. Tiers: sedation/positioning/ventilation → osmotherapy/CSF drainage/mild hyperventilation → barbiturates/craniectomy.
Key points
- Mild TBI mostly needs observation with CT by Canadian/New Orleans rules; beware delayed hemorrhage and anticoagulated/antiplatelet patients.
- Tier-1 measures (airway/analgesia-sedation, head-up 30°, normoventilation, CPP maintenance, treat fever/seizures) come before escalation.
- Tier-2 osmotherapy (mannitol 0.25–1 g/kg or hypertonic saline), CSF drainage and mild hyperventilation (PaCO₂ 32–35) precede refractory measures.
- Avoid hypotension (SBP < 90) and hypoxia throughout — both worsen secondary injury.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.