The Approaches and Decisions for Acute Pediatric Traumatic Brain Injury (ADAPT) Trial led by Drs. Michael Bell, at Children’s Hospital of Pittsburgh of UPMC and Stephen Wisniewski in the Graduate School of Public Health, has completed enrollment of its 1000 subjects. Funded by the National Institute of Neurological Disorders and Stroke and conceived and implemented by the Departments of Critical Care Medicine, the Safar Center for Resuscitation Research and the Department of Epidemiology in the Graduate School of Public Health at the University of Pittsburgh, the ADAPT Trial will compare the effectiveness of intracranial hypertension therapies, secondary insults and metabolic support in infants and children with severe traumatic brain injury (TBI). In addition to these primary goals, a number of secondary analyses are planned including the ability of various characteristics to predict mortality/outcomes, the effect of multi-system trauma on mortality from severe TBI and differences in the epidemiology of severe TBI across countries in the developed world. This cohort – generated from 50 clinical sites from 8 countries – is the largest studied to date in the field. At the completion of the follow-up and analysis phases of the study, several new Level II guidelines are anticipated to improve clinical care and enhance clinical research protocols for future trials. Drs. Bell and Wisniewski have led a pioneering study that has assembled a database of unprecedented magnitude in our field, from which we hope emerges important findings that will improve the care and outcomes of infants and children with severe TBI world-wide.