Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet Neurology, 24(6), 512–523. https://doi.org/10.1016/S1474-4422(25)00154-1 Dr. Geoffrey T. Manley et al.
Points
- A new framework developed by the NIH enhances traumatic brain injury assessment by integrating clinical evaluation, blood biomarkers, imaging, and patient-specific modifiers for more personalized care.
- Unlike the traditional Glasgow Coma Scale, the CBI-M framework includes detailed measures like pupillary reactivity and separates eye, verbal, and motor responses to define injury severity better.
- Blood biomarkers identify tissue damage, helping reduce unnecessary imaging, improving diagnostic efficiency, and minimizing radiation exposure and healthcare costs.
- Imaging with CT and MRI provides critical insight into structural brain damage, supporting accurate diagnoses and a better understanding of each patient’s injury.
- The framework is currently under validation in trauma centers and aims to improve acute and long-term care by offering a more comprehensive approach to managing traumatic brain injury.
Summary
A new multidimensional framework for TBI characterization has been developed in response to the limitations of the Glasgow Coma Scale (GCS) in assessing traumatic brain injury (TBI). The framework, introduced by the National Institutes of Health (NIH) and involving experts from 14 countries, includes four key pillars: clinical assessment (full GCS and pupillary reactivity), biomarker measures (blood-based tests), imaging (CT and MRI), and modifiers (factors influencing clinical presentation and outcomes). This comprehensive approach aims to provide a more accurate, individualized clinical management strategy, enhancing immediate care and long-term prognosis for TBI patients.
The CBI-M framework moves beyond the traditional categorization of TBI severity (mild, moderate, and severe) by integrating additional clinical assessments, such as the components of the GCS (eye, verbal, and motor responses). The biomarker pillar utilizes blood-based tests to identify tissue damage, allowing for more precise decisions about the need for imaging and avoiding unnecessary CT scans, thus reducing radiation exposure and healthcare costs. The imaging pillar further supports the diagnosis by identifying brain lesions, hemorrhages, and other structural abnormalities, essential for understanding the full extent of the injury.
Currently, the CBI-M framework is being trialed at trauma centers, where it is being validated and refined. The goal is to address gaps in primary prevention and enhance the scientific rigor of TBI management. Future research will focus on validating the framework’s applicability beyond the acute phase of TBI and developing strategies for its widespread clinical implementation. This innovative framework marks a significant step in improving the characterization of TBI and ensuring more effective patient care.
Link to the article: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00154-1/abstract
References Manley, G. T., Dams-O’Connor, K., Alosco, M. L., Awwad, H. O., Bazarian, J. J., Bragge, P., Corrigan, J. D., Doperalski, A., Ferguson, A. R., Mac Donald, C. L., Menon, D. K., McNett, M. M., Van Der Naalt, J., Nelson, L. D., Pisică, D., Silverberg, N. D., Umoh, N., Wilson, L., Yuh, E. L., … Yurgelun-Todd, D. (2025). A new characterisation of acute traumatic brain injury: The NIH-NINDS TBI Classification and Nomenclature Initiative. The Lancet Neurology, 24(6), 512–523. https://doi.org/10.1016/S1474-4422(25)00154-1
