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•TBI remain the most common problem that challenge all neurosurgeons•Many protocols of TBI treatment were developed to decreased morbidity and mortality•Traumatic coma databank was initiated and many researchs were done in U.S.A. and many centers:•Trauma system were settled &evaluated

•To study the outcome of the TBI treatment in Phramongkutkloa hospital•To determine the incidence of talk and deterioration•To identified the prognostic factor especially :time golden period

•Retrospective study• All TBI patients that arrive to PMK hospital between Jan. 2004-Jan.2008 were reviewed•TBI patients were classified 3 groups depended on levelof consciousness (GCS):mild,moderate ,severe•SPSS was used to analized the data •The outcome was evaluated by Glasskow Outcome Scale(GOS) at 1 year

•PMK Hospital: Trauma center level 1 :education&training,Standard of Service and resources• TBI 3450 patients : mild head injury 2000pts.,moderate -severe 1450pts •Moderate-severe TBI were admitted in the hospital and 540 pts were operated•Most common cause : Motor vehicle accident•Male:female 2:1•Age 1-89years ,most at 20-35years•Soldier 60%

•Patient that talk and deteriorated o.o5%(1/2000) :EDH&SDH Death from brain herniation ,Delay treatment•Diffused Axonal Injury (DAI) 16%,•EDH 20%•SDH 50%•Cerebral contussion 10%•Depressed skull fx 10%•Time between admit and operation :35 min-15 hours Mean 3 hours

•Protocol of treatment •Maintain normal Internalmileu&CBF HOB 30° neutral Position,Hyperventilation (PaCO2 30-35mmHg.),normovolumia,normoglycemia,normothermia,analgesic,anticonvulsant,sedative&paralytic drug Maintain CPP>70 mmHg.,ICP<20mmHg. High dose Barbiturate : 5%(Life saving 60%) ICP Monitoring 20% Craniotomy remove blood clot 30%, Decompressive craniectomy 70%

Prognostic factorPost resuscitation GCS <5AgeBrainstem reflex Pupillary size&responseComplication:consumptive coagulopathy,hypernatremia

• OUTCOME GOS1 (DEATH) 11% GOS2(Severe disability) 10% GOS3(Moderate disability) 9% GOS 4(Minimal disability) 20% GOS 5(Normal)50%

•Mostof TBI patients have better outcome (GOS 4,5 70%) •Sever e TBI :MR.=11% (Over all MR=1.7%)•Patient who talk and deteriorated 0.05%(1/2000)•Event no significant of time between admit and operation most patient have poor outcome if delay treatment >6 hours•Golden period depend on severity,age,compliance of brain,unexpected complication

EPIDERMIOLOGY UNITCOMPUTER CENTEREVERY PERSON WHO PARTICIPATE FOR SUCCESSION IN TBI TREATMENT