Reframing the “mild” in mild traumatic brain injury: A comprehensive narrative review of diagnosis and treatment paradigms

Abstract: Mild traumatic brain injury (mTBI) constitutes a pervasive yet often overlooked public health challenge with far-reaching implications for individual well-being and healthcare systems globally. This review synthesizes contemporary evidence on diagnosis, management, and emerging treatment paradigms for mTBI using a structured, comprehensive literature search strategy. Through comprehensive literature analysis spanning multiple databases—PubMed, Cochrane Library, EMBASE, and Web of Science—from January 2018 to January 2025. A total of 183 studies met inclusion criteria, comprising 42 systematic reviews and meta-analyses, 58 randomized controlled trials, and 83 observational studies. We have identified transformative advances in biomarker research, neuroimaging techniques, and targeted interventions while uncovering persistent challenges in standardizing diagnostic and treatment protocols. Recent randomized controlled trials and meta-analyses reveal promising outcomes for early intervention strategies, cognitive rehabilitation approaches, and novel pharmacological treatments. However, methodological limitations—including heterogeneous mTBI definitions, inconsistent outcome measures, and insufficient long-term follow-up—underscore the need for large-scale trials using standardized definitions and common data elements. Future research must prioritize personalized treatment approaches, integration of cutting-edge technology in assessment and monitoring, and addressing the troubling disparities in access to specialized care for mTBI patients—particularly among vulnerable populations.