THE NEW NIH-NINDS TBI Classification and Nomenclature Initiative introduces a multidimensional framework for acute traumatic brain injury (TBI), moving beyond traditional severity measures to integrate clinical, biomarker, imaging, and modifier pillars. This approach promises greater accuracy and individualisation in patient care.
Historically, TBI has been categorised as mild, moderate or severe based on the Glasgow Coma Scale (GCS) sum score. However, this method can overlook important aspects of injury and recovery, leading to inconsistencies in clinical management and research. Recognising these limitations, the National Institutes of Health launched a global collaboration in 2022, uniting experts, patients, and implementation scientists from 14 countries to develop a more comprehensive classification system.
The resulting framework, known as CBI-M, incorporates four key pillars: clinical assessment (complete GCS and pupillary reactivity), measurement of blood-based biomarkers, advanced neuroimaging of pathological changes, and modifiers that account for factors influencing outcomes. This system was built through literature reviews, wide-ranging expert consultations, and stakeholder feedback, ensuring both scientific rigour and practical utility. Major outcomes include clearer subtyping of TBI by severity and mechanism, integration of emerging technologies like MRI and functional imaging, and direct inclusion of patient perspectives. Studies show that the addition of objective biomarkers and imaging data can improve the prediction of clinical outcomes and guide personalised treatment strategies.
In the clinic, this new characterisation enables more tailored interventions and supports the development of evidence-based guidelines for TBI management. Its adoption could improve communication among healthcare teams and enhance research collaboration by standardising terminology. Ongoing research is set to explore new biomarkers and imaging methods to further improve diagnostic accuracy and patient outcomes.
Reference
Manley GT et al. A new characterisation of acute traumatic brain injury: the NIH-NINDS TBI Classification and Nomenclature Initiative. The Lancet Neurology. 2025;24(6):512-23.
