Traumatic brain injury: rethinking ideas and approaches.

摘要

In the past decade, evidence-based medicine has guided treatment of traumatic brain injury (TBI), with an increased number of systematic reviews leading to standardised treatment guidelines. Although some success has been achieved with this approach, it ignored substantial injury-specific and patient-specific variability. Clinical trials during this time had similar limitations because they unsuccessfully targeted discrete disease mechanisms in the hope of finding a magic bullet that would universally benefit all patients with TBI, and ignored underlying interindividual pathophysiological heterogeneity. In the past year there has been a shift in thinking, and recognition of the need for better, more uniform characterisation to guide management. Such characterisation, together with new developments, provides opportunities for personalised approaches to clinical management.