The features of the typical traumatic brain injury patient in the ICU are changing: what will this mean for the intensivist?

PURPOSE OF REVIEW: To describe the key features and epidemiology of traumatic brain injury (TBI) and how they may be changing, with an emphasis on how this may affect care in the intensive care unit. RECENT FINDINGS: TBI has been traditionally perceived as occurring mainly in a younger, predominantly male population injured in high velocity motor vehicle crashes or assaults. However, there are an increasing number of patients over 65 years who have sustained a TBI secondary to low velocity falls. Considering the effects of frailty, comorbidities and extracranial injuries is important when making management decisions. Mild TBI comprises a third of those admitted and as a significant proportion may have poor outcomes secondary to their TBI they should be assessed to ensure appropriate follow-up. Multimodal monitoring may offer a way in the future to offer more personalised management to this very complex and heterogeneous patient group. SUMMARY: This review highlights the urgent need to develop more age-inclusive TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing TBI population. Being elderly does not necessarily portend a poor outcome, and more research is needed to better triage, guide management and prognosticate on these patients.