Protocol for a review on neurosurgical intervention versus conservative management in older adults with traumatic brain injury

BackgroundTraumatic brain injury in older adults represents a serious public health challenge with complex management decisions. The aging population exhibits distinct pathophysiological responses to brain injury, altered recovery trajectories, and increased vulnerability to both surgical and medical complications. Decision-making regarding neurosurgical intervention versus conservative management remains contentious, with limited high-quality evidence specific to older populations. Existing guidelines predominantly derive from younger cohorts, potentially misaligning with the unique risk–benefit profiles of older adults.ObjectivesThis systematic review and meta-analysis protocol aims to synthesize evidence comparing neurosurgical intervention with conservative management for older adults with traumatic brain injury, examining functional outcomes, mortality, quality of life, and complications to inform evidence-based clinical decision-making.MethodsFollowing PRISMA-P guidelines, we will search PubMed, MEDLINE, Embase, Scopus, Cochrane Library, Web of Science, CINAHL, PsycINFO, and PEDro from inception to December 2025. Eligibility criteria include adults aged 65 years and older with traumatic brain injury comparing neurosurgical intervention with conservative management. Two reviewers will independently screen studies and extract data using standardized forms. Risk of bias assessment will employ the Cochrane RoB 2 tool for randomized trials and ROBINS-I for non-randomized studies. Random-effects meta-analysis will be conducted where appropriate, with heterogeneity assessed using I2 statistics. Subgroup analyses will explore age strata, injury severity, frailty status, and intervention types. GRADE methodology will evaluate certainty of evidence.DiscussionThis protocol establishes rigorous methodology for synthesizing comparative effectiveness evidence on neurosurgical versus conservative management in older adults with traumatic brain injury. Findings will address critical evidence gaps, informing clinical guidelines, shared decision-making frameworks, and research priorities for optimizing outcomes in this vulnerable population.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261376172, identifier PROSPERO (CRD420261376172).