LAUSR

B etween 2002 and 2006, approximately 1.7 million traumatic brain injuries (TBIs) occurred annually in the United States. With an average increase in incidence of 29.7 per 100,000 annually, the United States is expected to bear the burden of over 2.8 million TBIs in 2018. While acute survival after TBI continues to improve, advancements in optimizing long-term outcomes were less fruitful, and the average life expectancy for TBI survivors remains shortened by nearly a decade. The American College of Surgeons advocates that “acute care should be consistent with preservation of optimal functional recovery” and recommends initiating physiatrist-directed rehabilitation as soon as reasonably possible after injury. Physiatrists are medical doctors who focus on increasing functional capacity of patients during recovery and are well positioned to lead early rehabilitative efforts of TBI patients who require acute medical attention. Brain injuries are classified by severity. Patients with moderate-to-severe TBI are at higher risk of morbidity and mortality, and exercising early prudence in managing these patients can have profound effects on long-term outcomes. This commentary focuses on optimizing early management of moderateto-severe TBI patients in Level I or II trauma centers, with the understanding that the heterogenous presentation and nature of moderate-to-severe TBIs, among other factors, severely limit the availability of high-quality evidence. When TBI patients are admitted to a trauma center, the primary objective of the health care team is to hemodynamically and neurologically stabilize the patients. Once patients are medically stabilized, the priority shifts from survival to recovery. During this period, over 70% of TBI patients exhibit signs of confusion, agitation, amnesia, or impaired consciousness. This temporary state, during which the patient cannot form new memories, is termed posttraumatic amnesia (PTA), and is recognized as one of the best indicators of injury severity and prognosticators of long-term outcomes. Studies demonstrated that PTA duration has greater prognostic value for predicting functional and cognitive outcomes