Reframing traumatic brain injury and spinal cord injury as chronic multisystem disorders: toward integrated, long-term care.

Traumatic brain injury (TBI) and spinal cord injury (SCI) affect more than 220 million people worldwide and are associated with cardiometabolic, endocrine, neurological, and psychiatric sequelae for years to decades after an acute injury. However, most health systems still treat neurotrauma (TBI and SCI, collectively) as a time-limited event, leaving long-term surveillance of these patients fragmented or absent, which leads to preventable mortality and avoidable readmissions. TBI and SCI in adults should be reclassified as acute-onset multisystem chronic-risk conditions. Existing cardiovascular, endocrine, and psychiatric services do not capture neurotrauma-specific risks, including trauma-induced hypopituitarism, autonomic dysregulation, accelerated ageing, and cognitive-behavioural impairment, so neurotrauma care is best framed as a missing node in chronic neurological care. We propose a risk-stratified pathway of care navigation, multisystem screening, and telehealth; convergence with adjacent stroke, cardiometabolic, memory, psychiatric, pain, and epilepsy services; and the financing, workforce, and registry reforms needed to deliver measurable reductions in 5-year mortality, avoidable rehospitalisation, and long-term disability.