New TBI Practice Guidelines Published
New adapted clinical practice guidelines for the outpatient management of traumatic brain injury (TBI) have been published in Annals of Family Medicine. Developed by the Action Collaborative on TBI Care under the National Academies of Sciences, Engineering, and Medicine, this guideline aims to reduce variability and improve the quality of follow-up care provided to community-dwelling adults with TBI who are discharged from the hospital able to care for themselves or who did not require acute hospital care. The recommendations provide primary care clinicians with a practical, evidence-informed framework to support consistent assessment, follow-up, and recovery planning.
The guideline was created using the ADAPTE process, synthesizing recommendations from 18 existing evidence-based clinical practice guidelines. All recommendations were reclassified using the American Academy of Family Physicians’ adaptation of the GRADE system, with additional input gathered through a priority-setting process involving clinicians, individuals with lived experience, and caregivers. External review was conducted by 20 health professional and brain injury organizations. This approach results in a guideline that reflects both the best available evidence and real-world clinical considerations.
The guideline provides recommendations across 11 priority topics, including: confirming the diagnosis; determining when emergency department evaluation is needed; appropriate indications for neuroimaging and neuropsychological assessment; screening for social determinants of health; guidance on returning to usual activities; patient and family education; identifying risk factors for persistent symptoms; prioritizing symptom treatment; first-line management of posttraumatic headache; screening and treatment for mental health conditions; and identifying when referral to specialty care is warranted. These recommendations emphasize consistent clinical decision-making, equitable care delivery, and improved continuity across outpatient settings.
The working group highlights that outpatient TBI care remains highly variable and that many patients do not receive needed follow-up after emergency department discharge. By consolidating and adapting existing guidance, the goal is to provide clinicians—particularly in primary care—with clearer, more actionable recommendations to support recovery, reduce disparities, and promote patient-centered care.
Key recommendations in the published article include:
Confirm the diagnosis using standardized criteria and rule out alternative causes of symptoms.
Redirect patients for emergency department evaluation when concerning neurologic changes occur.
Order neuroimaging or neuropsychological assessment only when clinically indicated.
Screen for social determinants of health and incorporate them into care planning.
Provide guidance for return to usual activities based on individualized recovery.
Offer clear, culturally appropriate education to patients and families.
Assess risk factors for persistent symptoms and advise when follow-up is needed.
Prioritize symptoms to guide treatment sequencing.
Implement first-line management strategies for posttraumatic headache.
Screen and treat common mental health conditions following TBI.
Refer to specialty care when presentation or progress requires further expertise.
Source: Silverberg ND, Lee K, Mikolic A, et al. The Annals of Family Medicine Nov 2025, 23(6), 552–569.
DOI: 10.1370/afm.250352