Expert Consensus Guidelines for the Management of Traumatic Brain Injury—2026

Background: Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide, with a disproportionately high burden in lowand middle-income countries (LMICs).India accounts for nearly 10% of global road traffic-related deaths despite having approximately 1% of the world's vehicles.Variability in trauma systems, prehospital care, neurocritical resources, and rehabilitation services contributes to preventable mortality and long-term disability.Context-specific, evidence-informed guidance is required to harmonize care across resource-diverse settings.Objective: To develop comprehensive, evidence-based clinical practice guidelines for the management of TBI across the continuum of care in India.Methodology: The Society of Neurocritical Care (SNCC) Executive Committee constituted a multidisciplinary guideline-writing corresponding group comprising experts in neurocritical care, neurosurgery, emergency medicine, anesthesia, and rehabilitation.Structured literature searches were conducted across 11 predefined domains of TBI care.Evidence was synthesized into Population, Intervention, Comparator, Outcome (PICO) format clinical questions and appraised using the GRADE methodology.Certainty of evidence was categorized as high, moderate, low, or very low.Recommendations were formulated using the GRADE Evidence-to-Decision (EtD) framework, incorporating the balance of desirable and undesirable effects, resource availability, feasibility, cost, health equity, and acceptability.Recommendations are presented as strong ("we recommend") or conditional ("we suggest").Where evidence was insufficient, consensus-based best practice statements were developed using predefined voting thresholds.Such statements are labeled as best practice statements and are phrased as "we suggest (based on expert consensus)."Results: The guidelines provide domain-wise recommendations spanning prehospital systems, early hospital management, neuroimaging, intracranial pressure (ICP) monitoring, medical and surgical neurocritical care, respiratory and hemodynamic management, preventive and supportive care, prognostication, rehabilitation, and quality improvement.Conclusion: These guidelines offer a comprehensive, contextually adapted framework to standardize TBI management, reduce secondary brain injury, improve neurological outcomes, and strengthen neurotrauma systems in resource-variable environments.