Severe traumatic brain injury (STBI) is a pervasive disease that disproportionately affects young patients, elderly patients, and patients who were previously healthy. The neurologist’s roles in treating STBI are multiple, ranging from involvement in the acute critical care setting to managing the chronic sequelae that affect patients with STBI and their families. The search for effective treatments for STBI continues despite many so-called negative clinical trial results. To date, no generalizable therapy or intervention has proven to improve outcomes after STBI. In this Viewpoint, we discuss previously underrepresented factors crucial to making progress in STBI research: using precision medicine to design intervention trials and standardizing critical care management of patients with STBI, focusing specifically on differences in prognostication and withdrawal of life-sustaining therapy (WLST). Despite a historical lack of successful trials, we urge optimism because the future of clinical research in STBI is rich with opportunity.

严重的颅脑外伤（STBI）是一种普遍存在的疾病，严重影响了年轻患者，老年患者和以前健康的患者。神经科医生在治疗STBI中的作用是多种多样的，从参与急性重症监护环境到管理影响STBI患者及其家人的慢性后遗症不等。尽管有许多所谓的阴性临床试验结果，仍在继续寻找有效的STBI治疗方法。迄今为止，尚无可推广的疗法或干预措施能改善STBI后的疗效。在这种观点下，我们讨论了以前对STBI研究取得进展至关重要的代表性不足的因素：使用精密医学设计干预试验和标准化STBI患者的重症监护管理，特别关注于维持生命疗法（WLST）的预后和退出方面的差异。尽管历史上一直缺乏成功的试验，但我们仍应提倡乐观，因为STBI临床研究的未来充满机遇。