 Hennepin County Medical Center HCMC is a regional level 1 trauma center that serves the upper midwest and is one of the training sites for the University of Minnesota Neurosurgery Residency Program. As a large regional trauma center, there has historically been a large volume of severe TBI patients requiring neurosurgical intervention in the form of craniectomy or craniotomy with subsequent prolonged invasive neuromonitoring necessary as part of the clinical standard of care. The study population will be drawn from all trauma patients who present to the HCMC Emergency Department, trauma bay or as direct transfer to neurosurgery. 