Advances in the management of closed head injury

The management of closed head injury has improved recently. Mortality rates for severe trauma are lower and outcomes are more favorable. Advances are related to improved diagnostic tools, such as computerized tomography scanning, aggressive supportive care, standardized evaluation criteria, and program-oriented rehabilitation. Further progress depends on sophisticated triage, including delivery of the patient to an experienced head-injury unit, as well as successful manipulation of cellular and subcellular processes to maintain brain homeostasis. Recent developments in the pathophysiology, diagnosis, and treatment of closed head injury are reviewed, and promising research avenues are discussed.