This guide was informed by a the latest evidence and developed in consultation with a working group of clinicians.
It recognises the foundational importance of Country, culture, and community in the lives of Aboriginal peoples. It acknowledges the deep spiritual connection to land and waters (Country); the richness of traditional knowledge systems and cultural practices (culture); and the strength of kinship, social structures and collective identity (community).
These interconnected elements shape the lived experiences, wellbeing and resilience of Aboriginal peoples, which must be central to all care delivered, so it is appropriate, considerate and authentic.
Method
The guide is based on clinical expertise and high-level evidence. It replaces the NSW Institute of Trauma and Injury Management (ITIM) Adult Trauma Clinical Practice Guidelines, Initial Management of Closed Head Injury in Adults.
Two search methods were used in gaining information for this document: a database search and a grey literature search.
Database search
A PubMed search was conducted using terms below. Filters were added with a time range of 2018–2024 and in English. A total of 360 results were found. Manual reviewing distilled 4 relevant articles. Further resources were added by other contributors from the review group and ITIM.
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PubMed search terms
(("Brain Injuries"[Mesh] OR "Craniocerebral Trauma"[Mesh] OR "Head Injuries, Closed"[Mesh] OR"brain trauma"[tiab] OR "closed head injur*"[tiab] OR concuss*[tiab] OR mtbi[tiab] OR "mild tbi"[tiab] OR "moderate severe traumatic brain injury" [tiab] OR "mild traumatic brain injur*"[tiab])) AND (("practice guideline"[Publication Type] OR guideline[Publication Type] OR "guidelines as topic"[MeSH Terms] OR "guideline*"[Title] OR "guidance*"[Title] OR statement*[title])) Filters: from 2018 - 2024
Further searches on specific questions were undertaken. Information on these is available on request.
Grey literature search
Google search using Google Scholar using key terms such as “head injury guidelines”, “head injury guidelines American” and “mild tbi guidelines” and "moderate to severe tbi guidelines" in 2024. Only the first 3 pages (or top 20 hits) of the search results were screened. Other resources were added by other contributors from the Trauma Innovation Committee and ITIM.
Other articles that were not part of the initial search are referenced in this document and listed in the reference section.
Working group and expert consensus
A working group was formed to oversee and review this content. This included subject matter experts, such as emergency department clinicians, neurosurgeons, neurologists, brain injury rehabilitation specialists, paramedics, clinical nurse consultants and trauma surgeons . Consensus was achieved in consultation with these subject matter experts when required.
Acknowledgements
Thank you to the following clinicians who contributed to the development of this guide:
- Professor Zsolt Balogh, Director of Trauma Service, John Hunter Hospital
- Dr Stuart Browne, Clinical Director, Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation
- Leigh Bruce, Clinical Nurse Consultant, Neurosurgery
- Associate Professor Dane Chalkley, Co-Director Trauma Service, Senior Staff Specialist Emergency Medicine, Royal Prince Alfred Hospital
- Dr Trevor Chan, Clinical Director, Emergency Care Institute, Agency for Clinical Innovation
- Dr Edward Christian, Emergency Department Consultant, Dubbo Hospital
- Steph Hanlon, Trauma Clinical Nurse Consultant, Dubbo Hospital
- Peter Mackay, Trauma Clinical Nurse Consultant, Gosford Hospital
- Dr Valerie Malka, Clinical Director, Institute of Trauma and Injury Management, Agency for Clinical Innovation
- Dr Helen Oliver, Consultant in Pre-Hospital and Retrieval Medicine at NSW Ambulance Aeromedical Operations and Consultant in Anaesthesia at St George, Prince of Wales and Canterbury Hospitals
- Dr Gemma Olson, Neurosurgery, Westmead Hospital
- Dr Vincent Oxenham, Senior Clinical Neuropsychologist, Royal North Shore Hospital
- David Patterson, Intensive Care Paramedic, NSW Ambulance
- Dr Miriam Priglinger, Consultant Neurologist, Royal North Shore Hospital
- Dr Ganesh Shiva, Visiting Medical Officer Neurosurgeon, Liverpool Hospital
- Dr Tom Soeyland, Staff Specialist in Pre-hospital and Retrieval Medicine, Port Macquarie Hospital