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Mwandishi:

Mhariri:

Imeboreshwa:

ULY CLINIC

Dkt. Sospeter B, MD

18 Februari 2026, 07:57:24

Traumatic brain injuries (TBI)
Traumatic brain injuries (TBI)
Traumatic brain injuries (TBI)
Traumatic brain injuries (TBI)

Traumatic brain injuries (TBI)

Traumatic Brain Injury (TBI) is defined as an alteration in brain function or evidence of brain pathology caused by an external mechanical force. It is a major public health problem worldwide and a leading cause of death and disability, particularly among young adults and the elderly.1,2

Common causes include:

  • Road traffic crashes

  • Falls

  • Assaults

  • Sports injuries

  • Occupational injuries

TBI is classified clinically according to the Glasgow Coma Scale (GCS) into mild, moderate, and severe categories.


Classification


1. Mild Traumatic Brain Injury

  • GCS 13–14 (sometimes 13–15 depending on guideline definition)

  • Brief loss of consciousness (if present)

  • May have headache, dizziness, vomiting

  • Good recovery with minimal or no long-term sequelae


2. Moderate Traumatic Brain Injury

  • GCS 9–12

  • Confused or lethargic patient

  • May have focal neurological deficits

  • Able to follow simple commands

  • Possible mild long-term neurological sequelae

  • Generally good prognosis with appropriate management


3. Severe Traumatic Brain Injury

  • GCS ≤ 8 (definition of coma)

  • Unable to follow commands

  • Frequently requires airway protection

  • High mortality and significant long-term disability

  • Requires ICU-level neurocritical care


Pathophysiology

TBI consists of:


Primary injury

  • Occurs at the time of impact

  • Includes skull fractures, cerebral contusions, intracranial hematomas (epidural, subdural, intracerebral), diffuse axonal injury


Secondary injury

  • Occurs minutes to days after trauma

  • Caused by hypoxia, hypotension, cerebral edema, raised intracranial pressure (ICP), ischemia, excitotoxicity, inflammation

Prevention of secondary brain injury is the cornerstone of management.3,4


Signs and Symptoms

Symptoms vary according to severity:


General

  • Headache

  • Nausea and vomiting

  • Dizziness

  • Altered level of consciousness


Neurological

  • Confusion

  • Agitation

  • Seizures

  • Unequal pupils

  • Weakness or paralysis

  • Posturing (decorticate/decerebrate)


Red Flag Signs

  • Persistent vomiting

  • Seizures

  • Pupil asymmetry

  • Progressive drowsiness

  • CSF leak (blood or serous discharge from ear/nose)

  • Signs of skull fracture

Head injury may be associated with ophthalmic, ENT, and dental injuries, which require separate evaluation.


Diagnostic Criteria

Head injuries are classified into:

  1. Scalp injuries only

  2. Traumatic brain injury (intracranial involvement)

Diagnosis of TBI is based on:

  • History of head trauma

  • GCS scoring

  • Neurological examination

  • Brain imaging (CT scan)


Investigations


Imaging

  • Non-contrast CT scan of the brain (first-line investigation)

    • Absolute indication: GCS ≤ 8–9

    • Relative indication: GCS 10–14

  • MRI brain (for diffuse axonal injury or subacute cases)


Laboratory

  • Full blood count

  • Electrolytes

  • Blood glucose

  • Coagulation profile

  • Arterial blood gas

  • Toxicology screen if indicated


Monitoring

  • Continuous GCS monitoring

  • Pupil size and reactivity

  • Vital signs

  • ICP monitoring in severe cases (specialized centers)


Management

Management follows the ABCDE trauma protocol and depends on the level of care.


Community / Dispensary Level Interventions

  • Clean and dress wounds

  • Ensure airway patency if unconscious

  • Keep patient warm

  • Place patient in recovery (coma) position

  • Immobilize cervical spine with neck collar

  • Immediate referral to higher-level facility


Health Centre Level Interventions

  • Obtain full history

  • Follow ABCDE trauma protocol

  • Provide oxygen by mask or endotracheal tube if indicated

  • Establish IV access (Normal saline or Ringer’s lactate; avoid dextrose unless hypoglycemic)

  • Monitor vital signs and pupils

  • Catheterize if necessary

  • Surgical debridement and suturing of wounds

  • Refer moderate/severe TBI, seizures, or pupil asymmetry


Hospital Level Interventions

  • Repeat ABCDE assessment

  • Full neurological examination

  • Brain CT scan as indicated

  • ICU admission if GCS ≤ 8

  • Specialist consultation (neurosurgery)


Seizure Management

  • Diazepam 10 mg IV (as needed for active seizure)

  • Phenobarbitone 100 mg IV 8 hourly

  • Phenytoin 100 mg IV 8 hourly

(Short-term seizure prophylaxis may be given for severe TBI, typically for 7 days.)3


Severe Traumatic Brain Injury

Severe TBI is associated with:

  • High mortality

  • Permanent neurological disability

  • Cognitive impairment

  • Long-term rehabilitation needs


Management

  • ICU admission with neurocritical care monitoring

  • ICP monitoring (when available)

  • Maintain:

    • SBP ≥ 100–110 mmHg

    • Oxygen saturation ≥ 94%

    • ICP < 22 mmHg

  • Head elevation (30°)

  • Sedation and analgesia

  • Osmotherapy (mannitol or hypertonic saline if raised ICP)

  • Craniotomy/decompressive craniectomy for:

    • Intracranial hematomas

    • Depressed skull fractures

    • Refractory intracranial hypertension

  • Early multidisciplinary rehabilitation


Non-Pharmacological Management

  • Cervical spine stabilization

  • Positioning to reduce ICP

  • Early physiotherapy

  • Speech and occupational therapy

  • Nutritional support

  • Psychological support

  • Family counseling


Complications

  • Raised ICP

  • Brain herniation

  • Post-traumatic epilepsy

  • Hydrocephalus

  • Cognitive and behavioral disorders

  • Persistent vegetative state


Prevention

  • Helmet use (motorcycles, bicycles)

  • Seatbelt use

  • Fall prevention in elderly

  • Road safety enforcement

  • Alcohol control measures

  • Workplace safety policie


References

  1. Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987–1048.

  2. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury: a systematic review and meta-analysis. J Neurosurg. 2018;130(4):1080–97.

  3. Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15.

  4. Stocchetti N, Maas AIR. Traumatic intracranial hypertension. N Engl J Med. 2014;370(22):2121–30.

  5. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS®): Student Course Manual. 10th ed. Chicago (IL): American College of Surgeons; 2018.

  6. Brain Trauma Foundation. Guidelines for the Management of Severe Traumatic Brain Injury. 4th ed. New York (NY): Brain Trauma Foundation; 2016.

  7. World Health Organization. Guidelines for Essential Trauma Care. Geneva: WHO; 2004.

  8. Ministry of Health, Community Development, Gender, Elderly and Children (Tanzania). Standard Treatment Guidelines & Essential Medicines List. 6th ed. Dodoma: MoHCDGEC; 2023.


Imeandikwa,

18 Februari 2026, 07:57:24

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