US guidance on traumatic brain injury management

Brain Trauma Foundation,http://www.braintrauma.org

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality world wide. Yet despite this, there is a paucity of good quality research and higher levels of evidence in the area. For the enthusiast or for the simply interested, the website of the US Brain Trauma Foundation is an excellent resource.

The Brain Trauma Foundation is a group of neurosurgeons and associated experts in the area of neurotrauma based in New York who have developed guidelines and education packages in the area of TBI. On viewing the homepage one is struck by the clear quality of the formatting and ease of the navigation and links.

The guidelines are the pivotal area of the website. The available guidelines focus on pre-hospital management, general management of TBI, management of TBI in children and adolescents and surgical management. The first three are from 2000 and are thus a little dated, although an interim update was posted in 2003 and full updates are underway from this April. All the guidelines are based on thorough systematic reviews of the (at times scanty) evidence in TBI management and can be downloaded as PDFs.

Other areas of the website include recent news about relevant research in TBI, access to a bi-annual newsletter that seems to repeat the news stories and lunch lectures, and a subscription-only live interactive web based discussion about key topics such as nutrition and hypothermia. Unfortunately, lunchtime in the US may coincide with more nocturnal timings in European time zones. The education area is a developing package of internet based learning programs, which are password protected but fairly cheap at $30/year. It provides algorithms, lesson plans and training videos.

Best feature

The guidelines are the strength of the site and the main reason to visit.

Worst feature

It is a shame that the educational areas require subscription. It is also frustrating not to be able to print the PDFs of the guidelines.

Wish list

Our only criticism is the lack of an image databank and lack of an on-line educational resource such as basic neurophysiology and physiology of trauma. However, it outshines the European equivalent (European Brain Injury Consortium at http://www.homepages.ed.ac.uk/gdm/EBIC) and if used with http://www.trauma.org provides a complete resource.

Other links

Links are listed in the resources section and are extensive. They include American societies (including the Society of Critical Care Medicine (SCCM)), links to trauma systems (such as Eastern Association for the Surgery of Trauma (EAST) guidelines), evidence based medicine resources and an impressive list of hospital websites.