Updating Traumatic Brain Injury Classification for Surgeons: Integrating the CBI-M Framework Into Trauma and Acute...

Area of Science:

• Neurology
• Trauma Surgery
• Biomarkers

Background:

• Traumatic brain injury (TBI) is a leading cause of death and disability globally.
• Current Glasgow Coma Scale (GCS) classification lacks biological and contextual detail.
• A new Clinical-Biomarkers-Imaging-Modifiers (CBI-M) framework was proposed in January 2024 by the NINDS.

Purpose of the Study:

• To review the rationale, structure, and clinical relevance of the CBI-M framework.
• To inform trauma and acute care surgeons about the CBI-M framework.
• To highlight the shift towards a multidimensional TBI classification system.

Main Methods:

• Narrative literature review using PubMed and Scopus (2000-2024).
• Keywords: "traumatic brain injury," "classification," "biomarkers," "neuroimaging," "personalized medicine."
• Prioritization of consensus statements, multicenter studies (e.g., TRACK-TBI, CENTER-TBI), and NINDS workshop materials.

Main Results:

• The CBI-M framework integrates four domains: Clinical assessment, Biomarkers (GFAP, UCH-L1, S100B, NfL, pTau), Imaging (standardized CT terminology), and Modifiers (psychosocial, environmental, comorbidities).
• This multidimensional approach allows for more comprehensive TBI characterization.
• Potential to enhance interdisciplinary communication and structured documentation in trauma systems.

Conclusions:

• The CBI-M framework represents a shift from severity-based TBI classification to a multidomain approach.
• It offers trauma surgeons a structured method for documentation and integration with quality improvement initiatives.
• The framework is an evolving model requiring prospective validation for clinical applicability.