Approximately 50 million people around the world sustain a traumatic brain injury (TBI) each year — a growing percentage of those cases are due to cycling crashes — and still, there is a lack of consistency in treatment and follow-up care.
New guidelines drafted by the Action Collaborative on Traumatic Brain Injury Care, which was established in response to the 2022 National Academies’ TBI report, aim to change that. Eleven recommendations, jointly published in the Annals of Family Medicine and the Journal of Neurotrama in June 2025, seek to improve outpatient management of adults with TBI and focus on diagnosis, assessment, education, and specialty care.
The work is encouraging for many in the medical field, including Geoffrey Manley, a neurosurgeon at the University of California San Francisco, who leads the collaborative of about a dozen researchers and counts cases early in his career as motivators for the work.
Earlier this year, the group also published a paper proposing a new way to evaluate patients with TBI, saying that the Glasgow Coma Scale, which has widely been used to diagnose brain injuries, is insufficient.
“We know we can do much better than the age-old mild, moderate, severe categories,” collaborative member Michael McCrea, professor of neurosurgery at the Medical College of Wisconsin, told the New York Times. “It’s really just embarrassing.”
McCrea explains that what’s defined as a “mild” TBI isn’t always so mild, and likewise, some people with severe TBIs are able to make full recoveries. However, those classifications define the type of care the patient receives.
For cyclists, who commonly sustain TBIs in crashes, proper follow-up care is crucial to recovery. The collaborative researchers write that inadequate follow-up care is considered an “important contributor to poor TBI outcomes” and that even cases of TBI that don’t require hospital admission may still result in long-term symptoms and disability.
Understanding TBIs
While the cause of a TBI can happen in an instant, the recovery can take weeks or months and symptoms may linger for just as long. TBIs are notoriously difficult to diagnose and can even be misdiagnosed, leading to longer recovery times.
Symptoms of a TBI may include:
- Headache
- Loss of vision
- Nausea or vomiting
- Sensory problems, such as blurred vision or ringing in the ears
- Mood swings
- Memory problems
- Sleep disturbances
- Dizziness
- Confusion
What qualifies as a TBI and its severity is not the same across the board. Researchers at the JFK Johnson Rehabilitation Institute note that a variety of organizations, from the CDC to the World Health Organization to the American Congress of Rehabilitation Medicine all have differing definitions for mild TBIs.
New recommendations
Diagnosing a TBI is the first crucial piece of treating the condition and is a key component from the work by the Action Collaborative on Traumatic Brain Injury Care.
Often, these diagnoses may not be made by a physician specially trained in neurology. Rather, family physicians and emergency department doctors are often the ones determining if a TBI is present and how severe it is. This makes it especially important to have clear diagnostic criteria. From there, treatment, guidance, education, and the decision to seek specialty care can be made.
The recommendations advise health professionals treating patients with a TBI to:
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 about TBI recovery and self-management
7. Assess for risk of persisting symptoms
8. Prioritize which symptoms to target first
9. Initiate treatment for post-traumatic headache
10. Screen and initiate treatment for mental health disorders
11. Decide if and when to refer to specialty care
These guidelines were drafted for the use of health care providers, but can be helpful for patients to know as well.
Bike crashes and suspected TBIs
The field of TBI research is quickly evolving — and improving — however, crashes that cause TBIs are still happening all the time. After a crash, it can be challenging to get answers about TBI symptoms, receive the right kind of care, and sometimes even reach a diagnosis.
Seek professional opinions, ask questions, and take the time to recover. Researchers are even starting to believe that a TBI is more of a “chronic condition,” meaning that symptoms and experiences may be prolonged or change over time.
It’s important that this research continues to better help patients and their families. A cyclist who sustains a brain injury after a crash may have to live life differently for months, years, or the rest of their life. Some treatments and therapies can be beneficial, but they are often costly and require dedication and time. A personal injury lawsuit and compensation can lessen the burden of the cost and time it takes to recover from a TBI.
For the staff at Bay Area Bicycle Law, understanding the road to recovery from TBI after a crash is crucial to helping clients. We see these cases every day and are dedicated to helping cyclists get the compensation that allows them to return to their life as best as possible. With TBI cases especially, treatment can be nuanced and should be tailored to the individual. We understand the time it takes and the resources that are required to work through the symptoms.
To talk to a Bay Area Bicycle Law attorney about your TBI case, call (415) 466-8717 today. Consultations are always free.