Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide and has enormous implications not only economically, but also for patients,  families and society. The global incidence of TBI is rising, largely secondary to an increase in road traffic accidents and trauma related violence in low and middle income countries (LMICs). In high income countries (HICs) the demographics are changing with a reduction in traffic-related incidents and an increase in the incidence of falls, particularly in the over 65 years age group. Relevant yearly statistics include:

• For the European Union it has been estimated that at least 2.5 million new cases of TBI occur each year. 

• The standardised Eurostat data estimated that there were 1.5 million TBI-related hospital discharges and 57000 TBI related deaths in 2012 in the 28 member states of the EU. 

• In the Eurostat data the pooled age-adjusted incidence of TBI (hospital discharges) was 287·2 per 100000 people per year, with enormous differences between countries. These are likely to reflect differences in study methods rather than true variation. 

• The median age of patients in HICs has nearly doubled since the 1980s. 

• The male/female ratio is over 2:11  

Intensive care for patients with head injuries is a dynamic process starting at the scene of the accident. During the early stages of hospital care, the patient may require to be managed in a variety of locations including the emergency department (ED), the operating room (OR), the radiology department or the intensive care unit (ICU). It is in the best interests of patient’s care that the intensive care practitioner is thoroughly conversant with the practice of prehospital and immediate emergency care. They should also be aware of the longer-term outcomes and management of patients after TBI; not only to be aware of and prevent the sequelae of secondary injury, as well as avoidable long-term complications, but also to better facilitate the transition of care from the ICU to the ward and/or rehabilitation service.  

While the vast majority of patients (70 to 90%) with a TBI may be classified as mild, this module concentrates on the management of severe TBI. It is important to be aware of the possibility of a mild TBI, particularly when treating patients with polytrauma and/or spinal injuries in the ICU.