After more than 50 years, doctors are getting a new tool to better understand and treat traumatic brain injuries (TBI).
A new framework is being tested in trauma centers across the U.S. and is expected to improve how TBI is diagnosed and treated. Experts say this change could lead to better care, fewer premature decisions about life support, and new hope for many patients.
TBI happens when the brain is injured due to accidents like car crashes, falls, or violence. In 2021 alone, about 70,000 people in the U.S. died from TBI, and around half a million live with long-term disabilities caused by it. Until now, doctors mostly relied on a 50-year-old method called the Glasgow Coma Scale to assess these injuries.
This scale rates a patient’s level of consciousness and places them into one of three categories: mild, moderate, or severe. But this system does not give a complete picture of the patient’s condition.
The new system, known as CBI-M, was developed by a global team of experts led by the U.S. National Institutes of Health (NIH). It adds new tools like blood tests, brain scans, and background information about how the injury happened and the patient’s overall health. The new approach was published in the May 20 issue of Lancet Neurology.
Dr. Geoffrey Manley, a brain surgeon at UC San Francisco, says the new system will help doctors provide more accurate diagnoses and avoid harmful assumptions.
For example, some patients with a so-called “mild” concussion may go untreated and later suffer long-term problems. Others with “severe” diagnoses have recovered well, even though families were told to consider ending life support.
The new system includes four parts or “pillars”:
1. **Clinical**: This includes traditional tools like the Glasgow Coma Scale, as well as signs like memory loss, dizziness, headache, and how the eyes and pupils respond. These symptoms are still the first things doctors should check.
2. **Biomarkers**: These are special substances found in the blood that can show if brain tissue is damaged. Low levels can help doctors rule out serious injury, avoiding unnecessary CT scans. This saves money and limits exposure to radiation.
3. **Imaging**: For more serious cases, brain scans such as CT and MRI are used to find bleeding, swelling, or other signs of injury that could cause long-term problems.
4. **Modifiers**: This final part looks at how the injury occurred and other factors like the patient’s medical history, medications, mental health, or past brain injuries. It also considers the patient’s social support and living conditions.
Dr. Kristen Dams-O’Connor from Mount Sinai says these extra details are important for fully understanding a patient’s condition. For instance, someone with memory problems before the injury may need extra care, even if their brain scan looks normal.
This new system is now being tested in trauma centers. Doctors and researchers will study how well it works before using it more widely. If successful, it could change how brain injuries are treated, making care more personal and effective.
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The study is published in The Lancet Neurology.
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