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An international group of experts is urging health systems to treat adult traumatic brain injury and spinal cord injury as conditions that can carry multisystem risks long after acute care ends. Their Lancet Neurology paper proposes a prevention-focused care pathway, but the recommendations still need testing and implementation.
An international group of experts is calling for long-term, coordinated care for adults who have experienced traumatic brain injury (TBI) or spinal cord injury (SCI), arguing that health risks can persist or appear years after the initial event. In a paper published in The Lancet Neurology, the authors propose treating these injuries as acute-onset conditions with chronic, multisystem risks, rather than ending routine follow-up when acute treatment and rehabilitation are over.
The paper, titled “Reframing traumatic brain injury and spinal cord injury as chronic multisystem disorders: toward integrated, long-term care,” brings together evidence on health outcomes after TBI and SCI and sets out a proposed care framework. The authors report that complications can affect cardiovascular, metabolic, endocrine, neurological and psychiatric health, as well as day-to-day functioning. Some problems may persist; others may emerge well after the original injury.
To develop the framework, the researchers searched multiple databases for English-language studies published from 2020 to 2026, focusing on prospective research into longer-term outcomes. They also consulted international experts and stakeholders, then drew on established chronic-care models used in areas such as stroke, diabetes and cancer survivorship. The paper is a policy and care proposal; it does not report a trial demonstrating that the proposed pathway improves patient outcomes.
The proposed approach includes scheduled multisystem screening, care navigators who can help patients connect with services, telehealth and direct links to specialists. The authors describe a tiered model, from a core package for settings with limited resources to more intensive multidisciplinary care for people with complex needs. They also outline implementation priorities covering policy, clinical services, workforce development, equity and the need for economic evidence.
Why Follow-Up Could Change
The proposal addresses a gap between the length of time that patients may face health risks and the shorter period many systems organize care around. The authors say follow-up is often fragmented or absent after acute care and rehabilitation. In that situation, later complications may go unrecognized until they contribute to hospitalization, functional decline or other harm.
For patients and families, a structured route back to care could mean clearer information about potential long-term risks, a reliable contact and access to screening or specialist assessment. The paper argues that some later complications may be preventable, but it does not establish that every complication can be avoided or that the proposed services will produce a particular outcome. The practical impact will depend on whether health systems can fund and deliver follow-up over time.
The tiered design is intended to make the model usable in different settings. The authors suggest that, where specialist services are scarce, community health workers, mobile health tools, teleconsultation and a minimum dataset could offer a starting point. Whether those measures are sufficient, and how care should be tailored to different injuries and patient needs, will require further evaluation.
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Evidence Behind the Proposal
The paper builds on earlier work examining health outcomes among people who survive TBI or SCI. The source report describes studies led by Saef Izzy, Sandro Marini and colleagues over the previous seven years, including cohort analyses published in JAMA Network Open in 2022 and 2024, and in August and November 2025. Those studies reported higher rates of new cardiovascular, endocrine, neurological and psychiatric conditions among survivors.
The new paper moves from describing longer-term risks to proposing a way to organize care around them. Its central argument is that these injuries should be understood not only as acute events, but also as possible starting points for health changes that last for years or decades. The authors cite processes including chronic inflammation, accelerated biological aging and increased cardiometabolic risk as areas of concern; the paper presents these as part of the evidence informing its framework, not as inevitable outcomes for every survivor.
“The central message is that recovery and medical risk do not end at discharge.”
— The paper’s authors, as summarized in the News-Medical report
Questions Before Wider Adoption
The paper sets out a proposed care blueprint, not evidence from a prospective test of the full pathway. The source material does not specify which screening schedule would be appropriate for each patient, how long follow-up should continue, or which combination of services would provide the greatest benefit. It also does not provide estimates of the pathway’s costs or its effect on hospitalizations, disability or quality of life.
Implementation may vary by health system, available specialists and patient circumstances. The authors call for policy changes, payment reform and longitudinal registries, but it is not clear which governments or health organizations will adopt those measures or on what timetable. Further research is needed to identify which people face which risks and to evaluate whether the proposed services improve outcomes.
Testing the Care Pathway
The authors say their next research step is to study people living with TBI by combining longitudinal clinical records with multiomic data. They aim to learn why certain people develop particular long-term complications and to identify distinct risk profiles that could inform more tailored prevention.
They also plan to prospectively test the care pathways and interventions proposed in the paper. Until those studies are completed, the framework remains a set of recommendations rather than a proven standard of care. The paper does not announce a rollout date or identify a specific health system that has committed to adopting the model.
Key Questions
What are the experts proposing?
They propose treating adult traumatic brain and spinal cord injuries as events that can carry long-term, multisystem health risks, with coordinated follow-up beyond acute treatment and rehabilitation.
What might long-term follow-up include?
The suggested pathway includes scheduled screenings, care navigators, telehealth and links to specialist services. The authors describe different levels of care, depending on a health system’s resources and a patient’s needs.
Does the paper prove the proposed pathway works?
No. It reviews existing research and proposes a care framework. The authors say the pathway and its interventions still need to be tested prospectively.
What remains unknown?
The paper does not establish an ideal screening schedule, the long-term cost of the model or how much it would change patient outcomes. Research is also needed to identify who is most at risk and which services help them.
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