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Protocol for a review on neurosurgical intervention versus conservative management in older adults with traumatic brain injuryThis plan guides surgery choices for older adults with brain injuries to improve care

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Key Takeaway
Consider this protocol as a framework for future evidence synthesis on neurosurgical versus conservative management in older TBI patients.

This document is a protocol for a planned review on traumatic brain injury in adults aged 65 years and older. The scope is to compare neurosurgical intervention with conservative management. The authors plan to synthesize evidence on secondary outcomes including functional outcomes, mortality, quality of life, and complications.

The protocol does not report primary outcomes, sample size, setting, or follow-up duration. The authors acknowledge a key limitation: limited high-quality evidence specific to older populations. They will use GRADE methodology to evaluate the certainty of the evidence.

The authors state that practice relevance includes informing clinical guidelines, shared decision-making frameworks, and research priorities. No main results, safety data, or funding information are reported, as this is a planning document. The protocol does not provide pooled effect sizes or trial-level details.

Findings are not yet available as this is a protocol. The review is not yet conducted, and no conclusions can be drawn about the effectiveness or safety of the interventions.

This document is a plan for a future study, not the results of finished research. It focuses on adults aged sixty-five and older who have suffered a traumatic brain injury. The main goal is to decide when surgery is the right choice compared to managing the injury without operations.

Doctors will look at how surgery affects daily life, how long patients live, and how well they feel. They will also check for any problems that happen during or after the procedure. Because this is just a plan, no final answers are ready yet. The team will use a special method called GRADE to check how strong the evidence will be later.

This work is important for doctors making rules and helping families choose treatments. It helps ensure that older patients get the safest care possible. The study team knows that good data for this specific group is hard to find, so they are working to fill that gap.

Please remember that these findings are not available right now because the study has not finished. The final report will come much later after all the data is collected and reviewed.

What this means for you:
This is a research plan, not finished results, so no final answers about surgery for older brain injury patients are ready yet.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
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).
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