A new TBI framework goes beyond level of consciousness to include biomarkers, neuroimaging, and other ‘modifiers’ and is expected to lead to more accurate diagnosis and care.
A newly proposed framework expands assessment of acute TBI beyond the Glasgow Coma Scale to include biomarkers, CT and MRI scans, and “modifiers” such as other medical conditions and how the injury occurred.
Given its limitations, in 2022, the US National Institute of Neurological Disorders and Stroke launched an international initiative to develop a multidimensional classification system for acute TBI. The clinical pillar “should be assessed as first priority in all patients. Research has shown that the elements of this pillar are highly predictive of injury severity and patient outcome,” co-senior author Andrew Maas, MD, PhD, emeritus professor of neurosurgery, University of Antwerp, Antwerp, Belgium, said in a news release.The second pillar uses blood-based biomarkers to provide objective indicators of tissue damage.
This pillar focuses on CT, the most widely used imaging modality within the first 24 h of injury, but recognizes that MRI is more sensitive than CT and can provide additional information while acknowledging certain practicalities around its use in the acute phase. “One example is a patient with underlying cognitive impairment who may require acute monitoring for risk of clinical deterioration, regardless of findings on the initial clinical exam,” she said.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.The new assessment model is a “substantial advancement” in integrating the characterization of acute TBI but is “not yet ideal,” they wrote.
“Another deficiency of the CBI-M framework is that it cannot quantitatively or semiquantitatively assess the condition of patients with TBI yet,” they pointed out.
TBI Traumatic Brain Injury (TBI) Biomarker Biological Marker Multi-Biomarker Disease Activity MBDA Multibiomarker Disease Activity Injury Head Injury Injury To The Head Wound Management Wound Care Computed Tomography CT Ct Scan Glasgow Coma Scale Stroke Cerebrovascular Accident CVA Cerebrovascular Accident (CVA) Brain Coma Neuroimaging Blood Salary
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