{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T20:25:03Z","timestamp":1792873503426,"version":"4.5.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Traumatic 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\u2013benefit profiles of older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Following 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\u202fyears 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 I\n                      <jats:sup>2<\/jats:sup>\n                      statistics. Subgroup analyses will explore age strata, injury severity, frailty status, and intervention types. GRADE methodology will evaluate certainty of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261376172<\/jats:ext-link>\n                      , identifier PROSPERO (CRD420261376172).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1775791","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:39:25Z","timestamp":1779169165000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Neurosurgical intervention versus conservative management in older adults with traumatic brain injury: a protocol for a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Ravi","family":"Shankar","sequence":"first","affiliation":[{"name":"Clinical Research & Innovation Office, Tan Tock Seng Hospital, National Healthcare Group","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuen Ling","family":"Hue","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Tan Tock Seng Hospital","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Sui Geok","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Tan Tock Seng Hospital","place":["Singapore, Singapore"]},{"name":"Institute of Rehabilitation Excellence, Tan Tock Seng Hospital Rehabilitation Centre, Tan Tock Seng Hospital","place":["Singapore, Singapore"]},{"name":"Yong Loo Lin School of Medicine, National University of Singapore","place":["Singapore, Singapore"]},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University","place":["Singapore, Singapore"]},{"name":"Rehabilitation Research Institute of Singapore, Nanyang Technological University","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1089\/neu.2017.5371","article-title":"Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions","volume":"35","author":"Gardner","year":"2018","journal-title":"J Neurotrauma"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6609a1","article-title":"Traumatic brain injury-related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013","volume":"66","author":"Taylor","year":"2017","journal-title":"MMWR Surveill Summ"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1111\/j.1532-5415.2006.00894.x","article-title":"Traumatic brain injury in older adults: epidemiology, outcomes, and future implications","volume":"54","author":"Thompson","year":"2006","journal-title":"J Am Geriatr Soc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1821","DOI":"10.1016\/j.injury.2012.07.188","article-title":"Traumatic brain injury in older adults: characteristics, causes and consequences","volume":"43","author":"Harvey","year":"2012","journal-title":"Injury"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e71048","DOI":"10.1002\/brb3.71048","article-title":"Trends and disparities in fall-related head injury mortality among middle-aged and older adults (>55 years) in the United States: a 21-year National Analysis (1999-2020)","volume":"15","author":"Cheema","year":"2025","journal-title":"Brain Behav"},{"key":"ref6","first-page":"231","article-title":"Traumatic brain injury in the elderly: considerations in a series of 103 patients older than 70","volume":"56","author":"Gaetani","year":"2012","journal-title":"J Neurosurg Sci"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.bbi.2014.12.021","article-title":"Acute CSF interleukin-6 trajectories after TBI: associations with neuroinflammation, polytrauma, and outcome","volume":"45","author":"Kumar","year":"2015","journal-title":"Brain Behav Immun"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1136\/emermed-2016-206506","article-title":"Traumatic brain injuries in older adults-6 years of data for one UK trauma Centre: retrospective analysis of prospectively collected data","volume":"34","author":"Hawley","year":"2017","journal-title":"Emerg Med J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.1016\/j.wneu.2014.08.014","article-title":"Outcome and surgical management for geriatric traumatic brain injury: analysis of 888 cases registered in the Japan neurotrauma data bank","volume":"82","author":"Shimoda","year":"2014","journal-title":"World Neurosurg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.wneu.2011.10.030","article-title":"Age and salvageability: analysis of outcome of patients older than 65 years undergoing craniotomy for acute traumatic subdural hematoma","volume":"78","author":"Taussky","year":"2012","journal-title":"World Neurosurg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/S1474-4422(24)00454-X","article-title":"Unique considerations in the assessment and management of traumatic brain injury in older adults","volume":"24","author":"Depreitere","year":"2025","journal-title":"Lancet Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1227\/NEU.0000000000001432","article-title":"Guidelines for the management of severe traumatic brain injury, fourth edition","volume":"80","author":"Carney","year":"2017","journal-title":"Neurosurgery"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"171","DOI":"10.25259\/SNI_203_2022","article-title":"A scoping review on the challenges, improvement programs, sand relevant output metrics for neurotrauma services in major trauma centers","volume":"13","author":"Dasic","year":"2022","journal-title":"Surg Neurol Int"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev"},{"key":"ref15","doi-asserted-by":"crossref","DOI":"10.1002\/9780470712184","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2008"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1472-6947-7-16","article-title":"Utilization of the PICO framework to improve searching PubMed for clinical questions","volume":"7","author":"Schardt","year":"2007","journal-title":"BMC Med Inform Decis Mak"},{"key":"ref17","volume-title":"Covidence Systematic Review Software","year":"2022"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref21","first-page":"548","article-title":"Wartime neurosurgical experience in Lebanon, 1982-85. I: penetrating craniocerebral injuries","volume":"26","author":"Levi","year":"1990","journal-title":"Isr J Med Sci"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1775791\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:39:26Z","timestamp":1779169166000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1775791\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":21,"alternative-id":["10.3389\/fneur.2026.1775791"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1775791","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"article-number":"1775791"}}