Conclusions
Perhaps nowhere in medicine is the assessment of effectiveness more difficult to achieve than in the setting of severe TBI. Coupled with an already heterogeneous population in terms of structural brain injury, genetic and physiological backgrounds, mechanisms of injury, and polytrauma injury patterns, poorly controlled research conditions with multiple treatment variables make comparisons of any two treatments difficult. However, it is imperative that the TBI research community embraces this new framework. By designing innovative trials to address specific questions, developing high-quality registries, and maintaining robust data sets for longitudinal follow-up, our community will be able to provide ever more useful information for clinical decision making.