Table 1.

Evidence-Based Guidelines for Management of Traumatic Brain Injury (TBI): Strength of Recommendations

			Recommendations (n)
Guideline	Reference	Topics (n)	Class I	Class II	Class III
Prehospital management	Brain Trauma Foundation, 2000	7	0	5	12
Penetrating brain injury	Aarabi et al., 2001	7	0	0	12
Pediatric guidelines	Adelson et al., 2003	17	0	6	40
U.K. guidelines for triage, assessment, investigation, and management of TBI	U.K. National Institute for Health and Clinical Excellence, 2003	27	3	16	107
Field management of combat-related head trauma	Brain Trauma Foundation, 2005	5	0	3	15
Surgical management of TBI	Bullock et al., 2006	5	0	0	26
Revised guidelines for management of severe TBI	Brain Trauma Foundation, 2007	15	1	14	17
Total		83	4	44	229

Classification of evidence on therapeutic effectivenessa

Class I lack sufficient patient numbers, or suffer from other methodological inadequacies that render them class II or III.

Class II that were based on reliable data. Comparison of two or more groups must be clearly distinguished. Types of studies include observational, cohort, prevalence, and case-control. Class II evidence may also be derived from flawed RCTs.

Class III Types of studies include case series, databases or registries, case reports, and expert opinions. Class III evidence may also be derived from flawed RCTs, cohort, or case-control studies.

^aFrom Guidelines for the Management of Severe Traumatic Brain Injury, 3rd ed., Brain Trauma Foundation, www.tbiguidelines.org.

In the NICE guidelines (http://www.nice.org/), the grading scheme for level of recommendations was adapted from the Oxford Centre for Evidence Based Medicine levels of evidence as level A–D; for consistency, we considered grade A class I, grade B as class II, and grades C and D as class III.