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

Traumatic brain injury (TBI) remains a major cause of death and disability worldwide. Traditional classification based on the Glasgow Coma Scale (GCS) provides a shared clinical language but insufficiently captures the biological heterogeneity, imaging variability, and contextual modifiers that influence outcomes. In January 2024, the National Institute of Neurological Disorders and Stroke (NINDS) convened a multidisciplinary working group to propose the Clinical-Biomarkers-Imaging-Modifiers (CBI-M) framework. This review aims to summarize the rationale, structure, and potential clinical relevance of the CBI-M framework for trauma and acute care surgeons.

A narrative literature review was conducted using PubMed and Scopus databases with the terms "traumatic brain injury," "classification," "biomarkers," "neuroimaging," and "personalized medicine." Articles published between 2000 and 2024 were prioritized, with emphasis on consensus statements, multicenter cohort studies (e.g., TRACK-TBI, CENTER-TBI), and materials from the NINDS TBI Classification and Nomenclature Workshop. Reference lists were manually screened to identify additional relevant publications. The review synthesizes conceptual foundations, domain structure, and practical implementation considerations of the CBI-M model.

The CBI-M framework introduces a multidimensional and dynamic approach to TBI characterization by integrating four domains: Clinical assessment (detailed GCS components, pupillary reactivity, post-traumatic amnesia, and structured symptom documentation); Biomarkers, including GFAP, UCH-L1, S100 B, NfL, and pTau, which provide objective measures of neuronal and astroglial injury with defined temporal kinetics; Imaging, emphasizing standardized CT terminology within the first 24 h and harmonized radiologic lexicons; and Modifiers, incorporating psychosocial, environmental, and comorbidity factors that influence outcomes. This integrated model may support more comprehensive characterization of TBI, facilitate interdisciplinary communication, and enable structured documentation across trauma systems.

The CBI-M framework represents a conceptual shift from severity-based classification toward a multidomain approach to TBI characterization. For trauma surgeons, it offers a structured framework that may support more comprehensive documentation and facilitate integration with registry-based quality improvement and translational research. At present, its role is best understood as an evolving model with potential for future clinical applicability, pending prospective validation and assessment of feasibility across diverse trauma systems.