title: Adherence to Brain Trauma Foundation guidelines for management of traumatic brain injury patients: study protocol for a systematic review and meta-analysis.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a leading cause of death and disability around the world. Management based on Brain Trauma Foundation (BTF) guidelines is widely accepted and thought to improve outcome. The objectives of this systematic review are to give an overview of adherence to the BTF guidelines, describe factors influencing adherence, and study the effect of guideline-based management on outcome.
  
  
  METHODS
  We will search electronic bibliographic databases: PROSPERO, Medline, EMBASE, SCOPUS, NHS, CINAHL, Cochrane Database, and ProQuest Dissertations and Theses Global. Two investigators will independently screen all titles, abstracts, and articles and select Randomized Controlled Trial (RCT), cohort studies, case-control studies, and case series reporting the adherence rate, factors influencing adherence, and mortality or morbidity. These investigators will also independently extract data using a pre-designed and pilot-tested standardized electronic data extraction form and assess the risk of bias. We will exclude pediatric and military-related TBI studies, studies that included fewer than ten patients or addressed adherence to pre-hospital guidelines. Narrative synthesis and if appropriate, quantitative meta-analysis clustered by type of recommendation will be reported.
  
  
  CONCLUSIONS
  This study is expected to demonstrate the current level of professionals' adherence to BTF guidelines in patients with severe traumatic brain injury, it will describe the factors influencing adherence, which may provide valuable input for development of strategies to successfully increase adherence. In addition, if the studies are sufficiently homogenous, it will describe the effect of these guidelines on patient outcome.
  
  
  BACKGROUND
  PROSPERO CRD42015017794.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alberta and the University of Alberta Hospital, Edmonton, AB, Canada. khormi@ualberta.ca.|Faculty of medicine, Jazan University, Jazan, Saudi Arabia. khormi@ualberta.ca.
authors.forename: Yahya H
authors.initials: YH
authors.lastname: Khormi
authors.affiliation: Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, 11541, BO 2454, Riyadh, Kingdom of Saudi Arabia. gossady@hotmail.com.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Gosadi
authors.affiliation: John W. Scott Health Sciences Library, 2 K3.26 Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB, T6H 5L8, Canada. scampbel@ualberta.ca.
authors.forename: Sandra
authors.initials: S
authors.lastname: Campbell
authors.affiliation: School of Public Health, 3-276 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada. sentil@ualberta.ca.
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. cian.okelly@albertahealthservices.ca.
authors.forename: Cian
authors.initials: C
authors.lastname: O'kelly
authors.affiliation: Division of Critical Care Medicine, 2-124 Clinical Sciences Building, University of Alberta, Edmonton, AB, Canada. zygun@ualberta.ca.
authors.forename: David
authors.initials: D
authors.lastname: Zygun
mesh_terms: D001930:Brain Injuries / Q000628:therapy*; D005582:Foundations; D019983:Guideline Adherence; D006801:Humans; D015201:Meta-Analysis as Topic; D017410:Practice Guidelines as Topic; D012107:Research Design; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome