Our Summary

This research paper is about the challenges in treating patients who have had a severe traumatic brain injury (TBI) and multiple other injuries at the same time. There are no current guidelines for managing these complex cases, and the way they are treated can vary greatly around the world. To address this, the World Society of Emergency Surgery (WSES) organized a meeting with 40 experts, including emergency surgeons, neurosurgeons, and intensive care specialists. They used a method called the Delphi approach to come up with a consensus, agreeing on recommendations if at least 70% of the experts were in favor. They made 16 recommendations in total, aiming to improve the care given to these patients in the first 24 hours after their injury. The focus was on managing and monitoring bleeding and other aspects of trauma.

FAQs

  1. What was the purpose of the international consensus conference organized by the World Society of Emergency Surgery (WSES)?
  2. What approach was adopted in the WSES conference regarding the monitoring and management of severe adult TBI polytrauma patients?
  3. What was the main outcome of the consensus process among emergency surgeons, neurosurgeons, and intensivists involved in the conference?

Doctor’s Tip

One helpful tip a doctor might tell a patient about brain surgery is to follow all pre-operative instructions carefully, including fasting before the surgery and avoiding certain medications that could interfere with the procedure. It is also important to have a support system in place for after the surgery, as recovery can be challenging and require assistance with daily activities. Finally, it is important to communicate openly with your medical team and ask any questions or voice any concerns you may have about the procedure.

Suitable For

Patients who are typically recommended brain surgery include those with severe traumatic brain injury (TBI) and polytrauma. These patients may have significant bleeding or hemorrhage in the brain that requires surgical intervention to relieve pressure and prevent further damage. The decision to recommend brain surgery is often made based on the severity of the injury and the potential for improved outcomes with surgical treatment. Patients with severe TBI and polytrauma may require close monitoring and specialized care in the acute phase after injury to optimize their chances of recovery.

Timeline

Before brain surgery:

  • Patient is involved in a traumatic event, such as a car accident or fall, resulting in severe traumatic brain injury (TBI) and polytrauma.
  • Patient is transported to the emergency department and undergoes initial assessment and stabilization.
  • Patient may undergo diagnostic imaging, such as CT scans, to evaluate the extent of the brain injury.
  • Patient is monitored closely for signs of increased intracranial pressure and other complications.
  • Decision is made to proceed with brain surgery based on the severity of the injury and the patient’s clinical condition.

After brain surgery:

  • Patient undergoes surgery to repair or remove damaged tissue, relieve pressure on the brain, or address other issues related to the injury.
  • Patient is transferred to the intensive care unit for close monitoring and management.
  • Patient may require mechanical ventilation, medication to control pain and prevent infection, and other supportive care.
  • Patient undergoes frequent neurological examinations to assess brain function and monitor for complications.
  • Patient begins rehabilitation to regain lost skills and function, which may continue for weeks or months after surgery.

What to Ask Your Doctor

  1. What specific type of brain surgery is recommended for my condition?
  2. What are the potential risks and complications associated with this surgery?
  3. How long will the surgery take, and what is the expected recovery time?
  4. What type of anesthesia will be used during the surgery?
  5. What post-operative care will be required, and how long will I need to stay in the hospital?
  6. What are the potential long-term effects of the surgery on my brain function?
  7. Will I need any additional treatments or therapies after the surgery?
  8. What is the success rate of this type of surgery for patients with similar conditions?
  9. Are there any alternative treatment options available for my condition?
  10. What should I expect in terms of pain management during and after the surgery?

Reference

Authors: Picetti E, Rossi S, Abu-Zidan FM, Ansaloni L, Armonda R, Baiocchi GL, Bala M, Balogh ZJ, Berardino M, Biffl WL, Bouzat P, Buki A, Ceresoli M, Chesnut RM, Chiara O, Citerio G, Coccolini F, Coimbra R, Di Saverio S, Fraga GP, Gupta D, Helbok R, Hutchinson PJ, Kirkpatrick AW, Kinoshita T, Kluger Y, Leppaniemi A, Maas AIR, Maier RV, Minardi F, Moore EE, Myburgh JA, Okonkwo DO, Otomo Y, Rizoli S, Rubiano AM, Sahuquillo J, Sartelli M, Scalea TM, Servadei F, Stahel PF, Stocchetti N, Taccone FS, Tonetti T, Velmahos G, Weber D, Catena F. Journal: World J Emerg Surg. 2019 Nov 29;14:53. doi: 10.1186/s13017-019-0270-1. eCollection 2019. PMID: 31798673