Table 1.

Neuroworsening definition adopted by the SIBICC and CREVICE WGs [6^▪▪,7^▪▪,8]

Criticala neuroworsening	Sedation hold needed	Continuously monitored
Spontaneous decrease in GCS motor score of ≥1 point (compared with the previous examination)b	Yes	No
New focal motor deficit	Yes	No
New decrease/loss of pupillary reactivity	No	No
New pupillary asymmetry (≥2 mmc) or bilateral mydriasis	No	No
Herniation syndrome/Cushing's triad	No	Yes (ICP, HR, BP, RR)

BP, blood pressure; CREVICE, Consensus REVised Imaging and Clinical Examination; GCS, Glasgow Coma Scale; HR, heart rate; ICP, intracranial pressure; RR, respiratory rate; SIBICC, Seattle Severe Traumatic Brain Injury Consensus Conference; WG, working group.

^aThe term ’Critical’ neuroworsening is used specifically by the SIBICC WG to promote its recognition as a critical event and guide expeditious evaluation and consideration of empiric therapy.

^bThe ‘modified definition of neuroworsening’ now includes signs of the herniation syndrome and a lower threshold for GCS motor score (≥1 point).

^cPupillary asymmetry quantification of ≥2 mm only utilized in the CREVICE protocol, the SIBICC WG does not quantify the difference in pupillary asymmetry.