Traumatic brain injury (TBI) remains the commonest cause of death in the first four decades of life, accounting for 15–20% of deaths between 5 and 35 years.1 There is a ten-fold greater mortality in trauma patients with a head injury compared to those without.2 The effects of head injury for survivors, their families and for society can be devastating; TBI is the cause of severe disability for 150–200 people per million annually.3,4 Perhaps it is better if we do nothing, don't contact the neurosurgeons, don't admit them to specialist units, don't treat the pneumonia that develops – keep them comfortable, allow them some dignity? Or is this a situation where therapeutic nihilism leads to a self-fulfilling prophecy of poor outcome?
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