Severe TBI is defined as a GCS <= 8. Although accounting for only 10% of pediatric TBIs, severe TBI is responsible for almost all of the morbidity and mortality from TBI and from pediatric trauma in general. Its management begins in the field and in the ER with stabilization and prevention of secondary brain injury as discussed earlier. The in-hospital management centers on control of elevated ICP, which leads to most of the death and disability from severe TBI. In 1996, the Brain Trauma Foundation organized a joint effort that led to the publication of the guidelines for management of severe TBI in adults. These were updated in 2000. This document presented the available evidence leading to standards, guidelines and options for treatment of TBI. In 2003, the pediatric guidelines on this topic were published. Because of the limited data in the literature regarding severe pediatric TBI, almost the entire document consists of treatment options - no treatment standards were given. As an example of this paucity of evidence, only one clinical study of mannitol in pediatric TBI patients has been published, despite the fact that mannitol is an established therapy used world-wide for decades. The adult and pediatric guidelines, as well many others including St. John, developed treatment algorithms for severe TBI. All have in common a multi-tiered approach to the treatment of elevated ICP. While not strictly evidence based, they are attempts at standardizing treatment in a particular institution based on a consensus of the physicians involved. "Severe" Pages: 1 2 3 4 5 6 Next