Guidelines for the management of severe traumatic brain injury; Fourth edition

Brain Trama Foundation TBI Guidelines

In this 4th Edition of the Brain Trauma Foundation’s guidelines, there are 189 publications used for evidence—5 Class 1, 46 Class 2, 136 Class 3 studies, and 2 meta-analyses. Over the past 20 years, our community has evolved along with the science and application of evidencebased medicine in general. As a consequence, with each new iteration of the guidelines, we have applied the most current methodological standards and established more rigorous procedures for future work. This approach resulted in changes in the evaluation of previous work, an increase in the quality of the included studies, and essential improvements in the precision of the recommendations. The size of the literature base is a reflection of the rate at which new studies are being conducted that can be used as evidence for guideline recommendations. During the 7 years between the 3rd and 4th Editions of this work, 94 new studies were added to the library of evidence. Although there have been numerous new publications, many of them repeat the same methodological flaws found in previous research. The following is an examination of the current condition of brain trauma clinical research, our view of how this condition is defining and shaping our future, and a proposed solution in establishing a formal evidence-based consortium.