How Severe Is It? A Call to Action for Traumatic Brain Injury Classification

In 2024, Traumatic Brain Injury (TBI) experts from around the world convened at the National Institutes of Health for a two-day classification and nomenclature workshop to set into motion a new way of defining traumatic brain injury. The current, established system has survivors of TBI classified at Severe, Moderate or Mild and this is a designation that can follow a patient throughout their rehabilitation journey. It is also a classification system that does not paint an accurate or progressive holistic picture of each individual patient.

The proposed working framework involves four pillars or domains: Clinical, Biomarkers, Imaging and Modifiers or CBI-M. The clinical features would continue to incorporate the Glasgow Coma Scale (GCS) and pupil reactivity while blood-based biomarkers[1] focus on select biomarkers for specific use cases in certain settings at specified time points. From an imaging standpoint, this area addresses the importance of the role of scans such as CT and MRI in diagnosing and categorizing brain injury. Finally, the domain that allied health professionals realize is a crucial factor, modifiers or preinjury characteristics of the patient that could affect recovery, psychological factors and social and environmental factors such as the patient’s social support system, geography and access to care.

This new framework has direct implications for rehabilitation teams. By integrating biological markers with imaging and clinical factors, interdisciplinary teams can communicate across levels of care through this shared language more accurately to tailor interventions and predict recovery trajectories. 

References:

Menon, David K., et al. (May 20, 2025). Clinical Assessment on Days 1–14 for the Characterization of Traumatic Brain Injury: Recommendations from the 2024 NINDS Traumatic Brain Injury Classification and Nomenclature Initiative Clinical/Symptoms Working Group. Journal of Neurotrauma. https://doi.org/10.1089/neu.2024.0577

Moore, Lauren. (2024). The Next Big Step – Brain Injury Professionals Make Progress on TBI Reclassification Effort. The Challenge 18 (1), 10-11. https://biausa.org/public-affairs/public-awareness/challenge-magazine/the-lifelong-journey-of-brain-injury