It is estimated that, globally, 69 million people (95% CI 64-74 million) have a traumatic brain injury (TBI) each year [1]. High-income countries have nearly 3 times more cases than low-and middle-income countries (LMICs) [1]. This is relevant because TBI is the most common cause of subarachnoid hemorrhage (SAH). Thus, traumatic subarachnoid hemorrhage (TSAH) is a common finding in moderate and severe TBI (sTBI), because it occurs in 33%-60% of patients [2,3]. Road traffic accidents, falls, and violence are the main contributing factors to sTBI, and the majority of victims are in the prime of life (aged 15-44) and leading contributors to the country’s gross domestic product (GDP). Thus, a country’s economic security is affected by sTBI, and the country should have a vested interest in reducing its prevalence [4].

Although it is necessary to understand this condition’s pathophysiology more completely, some theories have been described in animal studies that could largely explain the clinical course of TSAH. These theories are principally concerned with the phenomenon of traumatic vasoconstriction, which contributes to secondary ischemic damage and has a variable incidence range of 19%-68%. Marmarou and associates [5] and Thomas and colleagues [6] used a rat model to describe the significant increase of intracranial pressure and mean arterial blood pressure changes that occur as a compensatory mechanism to maintain normal cerebral perfusion pressure [2].

TSAH has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. This is because of its related events of vasospasm, dyselectrolytemia, pituitary dysfunction, hypoxia, intracranial hypertension, and hydrocephalus [3].

Current resources aim to understand the diagnosis and treatment of patients with SAH according to the severity degree of the trauma. The goal is to use this information to evaluate the cost-effectiveness of current management, reduce the length of stay, and redirect the use of already limited resources [7]. Recently published studies have mentioned that patients with SAH secondary to mild TBI (mTBI) have a lower risk of clinical deterioration and that surgical intervention [8], along with the routine implementation of computed tomography scans, mandatory neurosurgery consultations, and high-intensity observations, is not necessary in most cases [7,8].

TSAH is a public health problem of significant proportions because of the global burden of disease and its disproportionate effect on LMICs. While research has made it possible to improve the use of resource-stratified clinical interventions, it is not enough [7]. Economies are dependent on fiscally active adults, and TSAH stunts the growth of GDP in LMICs. The implications, then, lie beyond the scope of medicine and must be taken up by economists and politicians.

The bone structure, clinical outcomes, and pathophysiology of TBI in the pediatric population differ from adults and thus were excluded from the review [9]. Therefore, the objective of this scoping review is to develop a better understanding of TSAH in the adult population. This scoping review will serve as an initial step in providing more evidence for health care professionals, economists, and policymakers so that they might devote more resources toward this significant problem affecting both health and economic outcomes worldwide.

A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews, and Joanna Briggs Institute (JBI) Evidence Synthesis was conducted, and no current or under way systematic reviews or scoping reviews on the topic were identified.

The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews [10]. The proposed methodology is presented in Figure 1.

No ethical approval will be required, as this review is based on already published data and does not involve interaction with human participants. The search for this systematic review commenced in December 2020, and we expect to publish the findings in early 2021. The plan for dissemination, however, is to publish the findings of the review in a peer-reviewed journal and present findings at high-level international conferences that engage the most pertinent stakeholders.

This protocol has been rigorously developed and designed specifically to identify and summarize the available literature regarding the diagnosis and management of TSAH. The results from this scoping review will serve as an initial step to provide greater evidence for health care professionals, economists, and policymakers to encourage them to devote more resources toward this significant problem affecting both health and economic outcomes worldwide. Preliminarily, we have observed that there is a paucity of information available for TSAH associated with sTBI and the evidence on TSAH. Furthermore, the evidence on mTBI greatly outweighs that which is available for TSAH and sTBI.