Nursing Protocols For Acute Traumatic Brain Injury: A Comprehensive Evidence-Based Review Across The Care Continuum

Abstract

Background

Traumatic brain injury (TBI) causes millions of cases yearly, with incidence over 250-300 per 100,000 person-years, leading to substantial mortality, long-term impairments, and economic costs exceeding billions annually, especially in low-resource settings. Marked outcome variations highlight the need for structured protocols to prevent secondary injury via airway protection, hemodynamic stability, and timely intervention.

Methods

This narrative synthesis critically appraises contemporary guidelines (e.g., Brain Trauma Foundation, NICE) and high-quality studies on protocols spanning prehospital, emergency, ICU, ward, and rehabilitation phases. Key questions address protocol components, comparative effectiveness versus non-protocolized care, evidence strength, and research gaps using GRADE-like grading for recommendations.​

Results

Protocols integrate ICP/CPP targets (ICP <22 mmHg, CPP 60-70 mmHg), multimodal monitoring, tiered ICP therapies, seizure prophylaxis, and early rehabilitation. Observational data show reduced mortality, improved functional outcomes (e.g., GOSE), shorter stays, and better adherence compared to variable care, though benefits vary by setting.​

Conclusions

Protocolized TBI management enhances outcomes by minimizing secondary injury; future efforts should prioritize precision approaches, resource adaptations, multicenter trials, and biomarkers for personalized care.​