Guidelines for the management of severe head injury in adults as evolv
ed by the European Brain Injury Consortium are presented and discussed
. The importance of preventing and treating secondary insults is empha
sized and the principles on which treatment is based are reviewed. Gui
delines presented are of a pragmatic nature, based on consensus and ex
pert opinion. covering the treatment from accident site to intensive c
are unit. Specific aspects pertaining to the conduct of clinical trial
s in head injury are highlighted. The adopted approach is further disc
ussed in relation to other approaches to the development of guidelines
, such as evidence based analysis.