Stephen Honeybul - Traumatic Brain Injury: Science, Practice, Evidence and Ethics

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It is often stated in the literature that traumatic brain injury TBI is a silent epidemic with an estimated 6474 million new cases presenting each year. It is called silent because the long-term impairments suffered by many TBI patients, such as memory loss, cognitive dysfunction or behavioural disturbance, are often not visible. However, there is a growing realization that robust pre-hospital, acute in-hospital, and post-acute/long-term care delivered by various disciplines with specific areas of expertise is paramount to optimize patient outcomes. As healthcare systems are implementing pathways for managing TBI patients from the scene of the injury and beyond discharge from the acute setting, we can be optimistic that the silence will eventually be broken.

At the same time, the involvement of several disciplines, each approaching the TBI patient from slightly different angles, poses a challenge. Different disciplines often use different languages and may approach the same issue in a different way. An appreciation of the key concepts underpinning TBI management by all disciplines involved is essential if we are to develop a common TBI language.

The first part covers topics that TBI books traditionally cover (i.e. epidemiology, pathophysiology) but we also wanted to touch upon novel insights generated by new disciplines (e.g. brain mechanics). The second part covers current clinical practice from the scene of the injury to long-term rehabilitation. We decided to have separate chapters discussing the management of TBI in resource-limited settings, as there is a growing appreciation that when the resources are vastly different, a one size fits all approach (or guideline) for high-income countries (HICs) and low- and middle-income countries (LMICs) is inappropriate. The third part is discussing evidence. We are proponents of evidence-based medicine, but we also appreciate its limitations. Hence, this part provides a critical appraisal of the evidence underpinning key interventions (e.g. hypothermia, decompressive craniectomy) and key aspects of TBI (e.g. long-term neurological consequences). The fourth and final part is covering ethical considerations. Perhaps there is no other medical field with so many ethical issues, which is a reflection of two parameters in the definition of TBI: sudden trauma due to an external force that causes an alteration of brain functioning.

We would like to thank the authors of all chapters, as without their time and effort, you would not be holding this book in your hands. We sincerely hope that this book will contribute to the development of a common TBI language for all disciplines striving to optimize the outcomes of patients who have been unfortunate to suffer a TBI.