Trauma centers across the United States are preparing to test a groundbreaking new approach for assessing traumatic brain injury (TBI), developed by an international coalition of experts and patients from 14 countries.
This initiative, led by the National Institutes of Health (NIH), is expected to lead to more accurate diagnoses, targeted treatments, and informed decisions around life-sustaining care.
Published in the May 20 issue of *Lancet Neurology*, the new framework moves beyond the traditional Glasgow Coma Scale — a 51-year-old system that categorizes TBIs as mild, moderate, or severe based solely on immediate clinical symptoms.
Instead, the new model integrates a four-pillar approach: clinical symptoms, biomarkers, imaging results, and contextual modifiers.
“This change is long overdue,” says Dr. Geoffrey Manley of UC San Francisco. “We’ve seen patients dismissed with ‘just a concussion’ who struggle for years, and others with ‘severe’ diagnoses who go on to lead normal lives. Our new framework aims to correct these disparities.”
The Clinical-Biomarker-Imaging-Modifiers (CBI-M) framework includes:
Clinical Pillar: Retains core elements of the Glasgow Coma Scale while expanding it to include symptoms like headache, dizziness, memory loss, and amnesia. Clinicians are urged to prioritize this assessment.
Biomarker Pillar: Uses blood-based markers to detect tissue damage, helping to identify those who need CT scans and those who can safely avoid unnecessary radiation. It also enables better patient selection for clinical trials.
Imaging Pillar: Utilizes CT and MRI to detect internal injuries such as bleeding or lesions, giving a clearer picture of both present and potential future symptoms.
Modifiers Pillar: Accounts for how the injury happened, previous TBIs, other medical conditions, medications, social determinants of health, and lifestyle — all of which affect recovery outcomes.
“This holistic approach means we can match the right patient with the right treatment and avoid life-altering decisions made on incomplete data,” said Dr. Michael McCrea, co-director of the Center for Neurotrauma Research at the Medical College of Wisconsin.
Importantly, the biomarkers are being used in a new nationwide trial at 18 trauma centers to test treatments for TBI — the first promising step toward drug development in more than three decades.
While the framework is still in trial rollout, its developers hope to fully implement it after refinement. If successful, it could transform how TBI is diagnosed, managed, and treated.
“This is about offering patients a more accurate diagnosis, better care, and more hope for recovery,” said Dr. Kristen Dams-O’Connor of Mount Sinai. “It’s the future of brain injury treatment.”
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The study is published in The Lancet Neurology.
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