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Intensive Care Medicine

, 34:1774 | Cite as

Bryan Jennett and the field of traumatic brain injury. His intellectual and ethical heritage in neuro-intensive care

  • Nino Stocchetti
  • Giuseppe CiterioEmail author
  • Andrew Maas
  • Peter Andrews
  • Graham Teasdale
Special Article

Abstract

William Bryan Jennett, one of the leading figures in neurosurgery of the twentieth century, has died on 26 January 2008, at the age of 81. He made fundamental contributions to the field of traumatic brain injury (TBI) that still shape diagnosis, management and prognosis worldwide, in the second part of the last century. This paper is meant to gratefully acknowledge his contributions and to reflect on the implications that his work has for neurointensive care today. Starting from his early steps, we tried to highlight his fundamental work on diagnosis of severity in TBI, on rescue, treatment and prognosis of severe TBI. Moreover, his contribution in the definition of vegetative state, minimally conscious state and brain death has been emphasized. The contribution of Professor Bryan Jennett was in fact seminal in many aspects: the application of a common language in brain damage evaluation, where GCS and GOS are now universally employed; a critical approach to TBI diagnosis and treatment, in the search of proven better therapies; a quantitative approach to TBI prognosis, based on large clinical series and appropriate statistics; a strong commitment to the ethical implication of survival after severe injury, including the vegetative status; social responsibility in the diagnosis of brain death and in organ donors procurement. For these reasons, he can be considered one of the leading figures in neurosurgery and neurology of the twentieth century. This paper is meant to gratefully acknowledge his contributions and to reflect on the implications that his work has for neuro-intensive care today.

Keywords

Glasgow Coma score Traumatic brain injury Brain death Vegetative state 

Notes

Conflict of interest and funding

None.

References

  1. 1.
    Jennett B, Teasdale G, Galbraith S, Pickard J, Grant H, Braakman R, Avezaat C, Maas A, Minderhoud J, Vecht CJ, Heiden J, Small R, Caton W, Kurze T (1977) Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291–298PubMedGoogle Scholar
  2. 2.
    Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. Lancet 2:81–84PubMedCrossRefGoogle Scholar
  3. 3.
    Teasdale G, Knill-Jones R, Van der Sande J (1987) Observer variability in assessing impaired consciousness and coma. J Neurol, Neurosurg Psychiatry 41:603–610Google Scholar
  4. 4.
    Braakman R, Avezaat CJ, Maas AI, Roel M, Schouten HJ (1977) Inter observer agreement in the assessment of the motor response of the Glasgow ‘coma’ scale. Clin Neurol Neurosurg 80:100–106PubMedCrossRefGoogle Scholar
  5. 5.
    Fielding K, Rowley G (1990) Reliability of assessments by skilled observers using the Glasgow Coma Scale. Aust J Adv Nurs 7:13–17PubMedGoogle Scholar
  6. 6.
    Menegazzi JJ, Davis EA, Sucov AN, Paris PM (1993) Reliability of the Glasgow Coma Scale when used by emergency physicians and paramedics. J Trauma 34:46–48PubMedGoogle Scholar
  7. 7.
    Jennett B (2005) Development of Glasgow coma and outcome scales. Nepal J Neurosci 2:24–28Google Scholar
  8. 8.
    Marmarou A, Lu J, Butcher I, McHugh GS, Murray GD, Steyerberg EW, Mushkudiani NA, Choi S, Maas AI (2007) Prognostic value of the Glasgow coma scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma 24:270–280PubMedCrossRefGoogle Scholar
  9. 9.
    Murray GD, Butcher I, McHugh GS, Mushkudiani NA, Maas AI, Marmarou A, Steyerberg EW (2007) Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J Neurotrauma 24:329–337PubMedCrossRefGoogle Scholar
  10. 10.
    Aarabi B, Alden TD, Chesnut RM, Downs JH III, Ecklund JM, Eisenberg HM, Farace E, Florin RE, Jane JAJR, Krieger MD, Maas AIR, Narayan RK, Potapov AA, Salazar AM, Shaffrey ME, Walters BC (2001) Vascular complications of PBI—in Guidelines. J Trauma 51:S26–S28Google Scholar
  11. 11.
    Balestreri M, Czosnyka M, Chatfield DA, Steiner LA, Schmidt EA, Smielewski P, Matta B, Pickard JD (2004) Predictive value of Glasgow coma scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry 75:161–162PubMedGoogle Scholar
  12. 12.
    Stocchetti N, Pagan F, Calappi E, Canavesi K, Beretta L, Citerio G, Cormio M, Colombo A (2004) Inaccurate early assessment of neurological severity in head injury. J Neurotrauma 21:1131–1140PubMedCrossRefGoogle Scholar
  13. 13.
    Jennett B (1978) If my son had a head injury. Br Med J 1:1601–1603PubMedCrossRefGoogle Scholar
  14. 14.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484PubMedCrossRefGoogle Scholar
  15. 15.
    Wilson JTL, Pettigrew LEL, Teasdale GM (1998) Structured interviews for the Glasgow outcome scale and the Extended Glasgow outcome scale: guidelines for their use. J Neurotrauma 15:573–585PubMedGoogle Scholar
  16. 16.
    Wilson JT, Slieker FJ, Legrand V, Murray G, Stocchetti N, Maas AI (2007) Observer variation in the assessment of outcome in traumatic brain injury: experience from a multicenter, international randomized clinical trial. Neurosurgery 61:123–129PubMedCrossRefGoogle Scholar
  17. 17.
    Jennett B, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R (1976) Predicting outcome in individual patients after severe head injury. Lancet 1:1031–1034PubMedCrossRefGoogle Scholar
  18. 18.
    Jennett B, Teasdale G, Braakman R, Minderhoud J, Heiden J, Kurze T (1979) Prognosis of patients with severe head injury. Neurosurgery 4:283–289PubMedCrossRefGoogle Scholar
  19. 19.
    Marmarou A, Lu J, Butcher I, McHugh GS, Murray GD, Steyerberg EW, Mushkudiani NA, Choi S, Maas AI (2007) Prognostic value of the Glasgow coma scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma 24:270–280PubMedCrossRefGoogle Scholar
  20. 20.
    Maas AIR, Marmarou A, Murray GD, Teasdale GM, Steyerberg EW (2007) Prognosis and clinical trial design in traumatic brain injury: the IMPACT study. J Neurotrauma 24:232–238PubMedCrossRefGoogle Scholar
  21. 21.
    Jennett B, Plum F (1972) Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1:734–737PubMedCrossRefGoogle Scholar
  22. 22.
    Graham DI, Maxwell WL, Adams JH, Jennett B (2005) Novel aspects of the neuropathology of the vegetative state after blunt head injury. Prog Brain Res 150:445–455PubMedCrossRefGoogle Scholar
  23. 23.
    Adams JH, Jennett B, McLellan DR, Murray LS, Graham DI (1999) The neuropathology of the vegetative state after head injury. J Clin Pathol 52:804–806PubMedGoogle Scholar
  24. 24.
    Adams JH, Graham DI, Jennett B (2000) The neuropathology of the vegetative state after an acute brain insult. Brain 123:1327–1338PubMedCrossRefGoogle Scholar
  25. 25.
    Jennett B (2005) Thirty years of the vegetative state: clinical, ethical and legal problems. Prog Brain Res 150:537–543PubMedCrossRefGoogle Scholar
  26. 26.
    Jennett B (2002) The vegetative state. J Neurol Neurosurg Psychiatry 73:355–357PubMedCrossRefGoogle Scholar
  27. 27.
    Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND (2002) The minimally conscious state: definition and diagnostic criteria. Neurology 58:349–353PubMedGoogle Scholar
  28. 28.
    Laureys S, Owen AM, Schiff ND (2004) Brain function in coma, vegetative state, and related disorders. Lancet Neurol 3:537–546PubMedCrossRefGoogle Scholar
  29. 29.
    Jennett B (1982) Brain death. Intensive Care Med 8:1–3PubMedCrossRefGoogle Scholar
  30. 30.
    Jennett B, Kennedy IM (1981) The brain death debate. Lancet 1:563–564PubMedCrossRefGoogle Scholar
  31. 31.
    Jennett B (1981) Brain death. Br J Anaesth 53:1111–1119PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Nino Stocchetti
    • 1
  • Giuseppe Citerio
    • 2
    Email author
  • Andrew Maas
    • 3
  • Peter Andrews
    • 4
  • Graham Teasdale
    • 5
  1. 1.Neuroscience Intensive Care UnitUniversity of Milan, Ospedale Maggiore Policlinico, Mangiagalli, e Regina Elena, Fondazione IRCCSMilanItaly
  2. 2.Dipartimento di Medicina Perioperatoria e Terapie IntensiveNeuroICU, H San Gerardo, via Pergolesi 33MonzaItaly
  3. 3.Department of NeurosurgeryUniversity HospitalAntwerpBelgium
  4. 4.Critical Care ServicesWestern General Hospital, University of EdinburghEdinburghUK
  5. 5.Quality Improvement ScotlandNHSGlasgowUK

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