New Traumatic Brain Injury Framework Proposed
A new traumatic brain injury (TBI) classification system that expands the existing Glasgow Coma Scale (GCS) has been proposed.
Authors published their proposal as a policy view paper in Lancet Neurology in response to a call from the US National Institutes of Health-National Institute of Neurological Disorders and Stroke (NINDS) in 2022 to address the need for a new, more accurate framework for characterizing TBI, particularly during the acute phase of injury.
The proposed new framework, known as CBI-M, has 4 pillars. The clinical pillar assesses full GCS and pupillary reactivity. The biomarker pillar evaluates blood-based measures including glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), or S100 calcium-binding protein B (S100B). The imaging pillar uses CT and MRI to examine intracranial damage. The modifier pillar considers features influencing clinical presentation and outcome, such as comorbidities or circumstances surrounding the injury.
“The CBI-M framework provides a multidimensional characterization of TBI to inform individualized clinical management and to improve scientific rigor,” the authors wrote. “Research priorities include validation of the CBI-M framework, evaluation of its applicability beyond the acute phase of TBI, and strategies for clinical implementation.”
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The new framework may lead to improved diagnosis and treatment, as well as provide additional information to consider in discussions about life support.
Notably, the novel framework maintains the GCS at its center as a first-line approach to evaluating TBI in patients.
"This pillar should be assessed as first priority in all patients," said co-author Andrew Maas, MD, PhD, of the Antwerp University Hospital in Belgium. "Research has shown that the elements of this pillar are highly predictive of injury severity and patient outcome."
The framework is intended for all patients presenting with TBI, and the order in which the pillars are assessed would depending on the patient’s condition as well as resource availability.
"We do not present this framework as a finished product," co-authors emphasized. "The framework will require refinement and validation in large contemporary studies before being considered for implementation into general clinical practice."
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