Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

[...]it might also be possible to specifically target individuals to address their patterns of risk-taking behaviour.183 Irrespective of the target population, information campaigns should employ a range of measures to raise awareness of key issues in prevention and care for TBI. Since awareness of child abuse has increased and family risk factors have been elucidated, local programmes have been developed in the USA and other countries to educate parents about the dangers and long-term effects of brain injury, and to provide caregiver relief and advice on coping skills for stress. The GCS42 is the most commonly used approach to quantify the clinical severity of TBI358 (figure 2), but this is relatively crude and does not reflect different pathoanatomical subsets of TBI. [...]the increasing use of prehospital sedation and tracheal intubation often confounds assessment with the GCS and has reduced its usefulness as a metric of injury severity.359 Existing International Classification of Diseases codes360 also do not adequately capture severity of TBI.361 Alternative TBI coding taxonomies-including the Abbreviated Injury Scale (AIS), which categorises severity of intracranial and extracranial injury,362 and the Marshall classification system, which is based on head CT findings363-are anatomically oriented and summarise the type, location, and severity of injuries. [...]current management strategies are based on guidelines that favour a one-size-fits-all approach, and the care of patients with TBI is therefore poorly individualised (section 5). [...]despite investment of many billions of dollars by pharmaceutical companies, no effective drugs exist for treatment in the acute setting-a failing due, in part, to insufficient targeting of therapies to patients in whom the relevant mechanism is active.