Management of brain and spine injuries

Over the past 30 years, remarkable progress has been made in improving outcome from traumatic brain injury (TBI). Overall mortalities from severe TBI have dropped from in the range of 36% in the late 1980s into the low-to-middle teens at specialized TBI centers [1,2]. Although many etiologies for such improvement have been suggested, it is unclear what changes actually affected the improvement in outcome. Despite the fervor for laboratory investigations of TBI models, it is sobering to recognize that no treatments have come from bench to bedside. As such, there are no magic bullets in the treatment of central nervous system (CNS) trauma in general, and TBI in particular. Instead, it appears to be a combination of many improvements in brain injury care, trauma systems, and critical care that has produced the decrease in mortality.