Early Physiological and Neurological Monitoring after Traumatic Brain Injury as Foundations for Outcome Prediction: A Narrative Review

Abstract Early physiological and neurological monitoring provides the first opportunity to identify and modify the determinants of outcome after traumatic brain injury. This narrative review examines how monitoring conducted in the prehospital and emergency phases can serve not only to guide immediate stabilization but also to generate data with prognostic value. Hypotension, hypoxia, hypocapnia, hyperthermia, and hyperglycemia remain key secondary insults that worsen mortality and functional recovery. Systematic assessment of oxygenation, end-tidal CO₂, and hemodynamic variables, together with neurological indices such as the Glasgow Coma Scale (GCS), GCS-P, pupillary reactivity, and early computed tomography findings, enables a multidimensional appraisal of cerebral vulnerability. Quantitative pupillometry, point-of-care lactate measurement, near-infrared spectroscopy, and optic nerve sheath ultrasonography are expanding this capability into the prehospital environment. Despite accumulating evidence, inconsistencies in data capture, training, and standardization limit widespread adoption. Ethical implementation demands accurate interpretation, protection of patient privacy, and equitable access to monitoring technology across healthcare systems. Future research should prioritize multicenter prospective studies, harmonized data definitions, and competency-based training to determine which early physiological and neurological parameters most reliably predict recovery. Outcome prediction-oriented monitoring reframes early neurotrauma management as a proactive, evidence-based process. By linking physiological surveillance with prognostication, it transforms the first hours of care from reactive resuscitation into the foundation of precision neurotrauma practice.