Mwandishi:
Mhariri:
Imeboreshwa:
ULY CLINIC
Dkt. Sospeter B, MD
18 Februari 2026, 07:57:24

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:
Scalp injuries only
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
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.
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.
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.
Stocchetti N, Maas AIR. Traumatic intracranial hypertension. N Engl J Med. 2014;370(22):2121–30.
American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS®): Student Course Manual. 10th ed. Chicago (IL): American College of Surgeons; 2018.
Brain Trauma Foundation. Guidelines for the Management of Severe Traumatic Brain Injury. 4th ed. New York (NY): Brain Trauma Foundation; 2016.
World Health Organization. Guidelines for Essential Trauma Care. Geneva: WHO; 2004.
Ministry of Health, Community Development, Gender, Elderly and Children (Tanzania). Standard Treatment Guidelines & Essential Medicines List. 6th ed. Dodoma: MoHCDGEC; 2023.
