Brain Injury Classification
“ This initiative to establish a new framework reflects years of research and collaboration among scientists, clinicians, and federal agencies,” says Dr. Dams-O’ Connor
Issue 34.3 outcomes, and they often do not accurately reflect the structural or physiological injuries sustained.
“ Importantly, these crude categories have, in many cases, posed barriers to care. For example, a person with a very‘ severe’ TBI may be denied access to aggressive life-sustaining care, or the symptoms of a person with a‘ mild’ TBI may be minimized or disregarded.”
For more than 50 years, clinicians have used the Glasgow Coma Scale( GCS) to assess patients with TBI, classifying them into mild, moderate, and severe categories based on their level of consciousness and a few other clinical symptoms. That initial diagnosis determined the level of care the patients received in both the emergency department and afterwards, and did not take into account important modifiers that may influence the GCS, which will now be included.
The new framework, known as CBI-M, comprises four pillars— clinical, biomarkers, imaging, and modifiers— and was developed by working groups of more than 100 TBI experts, researchers, patients, and the National Institute for Neurological Disorders and Stroke( NINDS). new framework into clinical practice.
“ The second pillar uses biomarkers identified in blood tests to provide objective indicators of tissue damage, overcoming the limitations of clinical assessment that may inadvertently include symptoms unrelated to TBI. Low levels of these biomarkers determine which patients do not require CT scans, reducing unnecessary radiation exposure and health care costs.
“ These patients can then be discharged. In those with more severe injuries, CT and MRI imaging— the framework’ s third pillar— are important for identifying blood clots, bleeding, and lesions that point to present and future symptoms.”
The proposed framework is being phased in at trauma centers on a trial basis. It will be refined and validated before it is fully implemented. g
Brain Injury Classification
“ This initiative to establish a new framework reflects years of research and collaboration among scientists, clinicians, and federal agencies,” says Dr. Dams-O’ Connor
“ This initiative to establish a new framework reflects years of research and collaboration |
CLINICAL |
BIOMARKERS |
IMAGING |
MODIFIERS |
among scientists, clinicians, and federal |
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agencies,” said Dr. Dams-O’ Connor, who |
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serves as a member of the NINDS steering |
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committee on improving TBI characterization. |
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“ Federal investments in large-scale, longitudinal |
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studies have provided the data needed to |
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discover that the GCS is even more informative when we consider its component parts separately— for example, eye, verbal and motor responses.
“ Building upon the strength of this internationally used scale, while bringing in additional clinical assessments that permit more detailed severity characterization, is foundational to the first pillar( clinical) of the CBI-M model,
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Assesses symptoms and responses using tools like the Glasgow Coma Scale and functional evaluations. |
Uses blood tests to detect indicators of brain injury at at molecular level. |
Relies on CT or MRI scans to visualize structural damage such as bleeding or lesions. |
Considers additional factors— like age, health history, or prior injuries— that can influence outcomes. |
which I think will help support adoption of the |
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