New Clinical Practice Guideline: Recommendations for primary care doctors treating adults with mTBI
By Zoe Marquis. This article was initially published in the 12/11/25 Edition of our Concussion Update newsletter; please consider subscribing.
Outpatient TBI care is highly variable, and many patients do not receive the care they need. In fact, according to one study, only 42% of mild TBI patients report receiving educational material at discharge from the emergency department, and only 52% of patients experiencing postconcussive symptoms report having seen a practitioner within 3 months following injury. To address this problem, a new Clinical Practice Guideline (CPG) on traumatic brain injury care was recently published in the Journal of Neurotrauma.
Written by Noah D. Silverberg et al., the guideline is meant for primary care providers treating adults with traumatic brain injury (TBI) who require brief or no hospital care; this includes a range of TBIs, including concussions. Clinical Practice Guidelines (CPGs) have been developed for the acute management of severe traumatic brain injury (TBI) as well as for mild TBI (concussion) in children, sport, and military settings. However, this is the first guideline that applies to adults with TBI who have been discharged after going to the emergency department (or urgent care), who were not hospitalized, or who went directly to their primary care provider.
The CPG includes 11 recommendations:
(1) confirm the diagnosis;
(2) determine whether emergency department evaluation is required;
(3) request neuroimaging and neuropsychological assessment when indicated;
(4) screen for social determinants of health;
(5) provide guidance on return to usual activities;
(6) educate the patient and family;
(7) assess for risk of persistent symptoms;
(8) prioritize which symptoms to target first;
(9) initiate treatment for posttraumatic headache;
(10) screen and initiate treatment for mental health disorders; and
(11) decide if and when to refer to specialty care.
These recommendations are meant to reduce variability in post-acute outpatient TBI care.
Notably, the guidelines include updated information about returning to activities, recommending relative rest for up to two days after injury, followed by a gradual return to activities as symptoms allow. This recommendation is an important step towards putting the most up-to-date information into practice. The guidelines also recommend considering risk factors for persisting symptoms—such as social determinants of health, burden of post-concussion symptoms, and mental health symptoms—and beginning treatment for post-traumatic headache. These steps can make a huge difference for patients experiencing (or at risk of experiencing) persisting symptoms.
The CPG was developed as part of an action collaborative under the auspices of the National Academies of Sciences, Engineering, and Medicine. The bulk of the evaluation and synthesis was completed by a core working group, but health professionals and brain injury organizations, as well as individuals with lived experience with TBI, were involved in key steps. The working group carried out a rigorous process including identifying and evaluating existing guidelines, conducting a survey of clinicians and people with lived experience to prioritize topics, synthesizing existing guidelines into recommendations based on prioritized topics, external review by health professional and brain injury organizations, and revisions. Recommendations are rated as “strong for or against,” “weak for or against,” or “good practice,” in order of descending strength of evidence. The group notes that further research is needed into “weak for or against” and “good practice” recommendations.
