Background: TBI is a leading cause of death and disability. Management based on the BTF guidelines is widely accepted and thought to improve outcome. The objectives of this study were: 1) to review the rate of adherence to BTF guidelines; 2) to identify factors influencing adherence; and 3) to determine the effect of guideline-based management on outcome. Methods: We searched all electronic bibliographic databases. In duplicate and independently, two investigators screened titles, abstracts and articles to select appropriate studies reporting compliance rate, factors influencing compliance, and adjusted mortality or morbidity. Data extraction and assessment of bias risk were performed independently by both investigators. We excluded pediatric and military-related TBI studies. Results: A total of 30 articles met inclusion/exclusion criteria out of 1153 papers screened. Most are retrospective and cross-sectional observational studies; there were no randomized control trials. Preliminary analysis showed considerable variation in compliance rate with BTF guidelines ranging from 5.6-96%. Conclusions: Variation in the care of TBI patients persists across the world. Compliance with BTF guidelines was strongly influenced by implementing a guidelines-based protocol. Heterogeneity of the article prevents outcome assessment. Well-conducted study to support the existing literature of the beneficial effect of current guidelines is needed.