Comparison of recommendations for initial adult traumatic brain injury management across clinical practice guidelines and consensus statements: a scoping review

OBJECTIVE: Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. We conducted a scoping review to identify, map, and compare recommendations for the initial medical management of adult TBI. METHODS: Following Joanna Briggs Institute methodology and PRISMA-ScR, we searched PubMed/MEDLINE, Embase, Scopus, guideline repositories, and gray literature for English or Spanish language documents published from 2010 to 2026. Two reviewers independently screened records, charted recommendations across domains, and rated agreement using a priori categories; discrepancies were resolved by consensus or third reviewer. RESULTS: Sixteen documents met inclusion criteria, including guidelines, consensus statements, and best-practice recommendations. Broad agreement existed for early neurological assessment, airway protection, avoidance of hypotension and hypoxemia, and timely neuroimaging. Heterogeneity remained in blood pressure and cerebral perfusion pressure targets, repeat imaging, definitions of neurological deterioration, escalation criteria, observation protocols, and discharge processes. Anticonvulsant prophylaxis and venous thromboembolism prevention were inconsistently addressed. Blood-based biomarkers appeared in only three documents and were limited to computed tomography decision-making. CONCLUSIONS: Although the fundamental principles of care were largely consistent, important differences remain in their operational implementation. Greater harmonization of clinical definitions and management pathways may facilitate more consistent application of evidence-based recommendations across healthcare settings.