Advances in Multimodality Monitoring in Traumatic Brain Injury

Multimodal monitoring (MMM) has the potential to transform the management of secondary brain injury following traumatic brain injury (TBI) to enable more personalized care. Despite its promise, the optimal combination of monitoring modalities and the interpretation of complex data streams remain insufficiently mature for MMM to be considered standard of care. This review evaluates the current state of MMM technologies, their clinical applications, and their emerging role in improving TBI management and guiding the path toward broader clinical adoption. This review focuses on real-time physiological data streams that can provide management guidance in a time frame commensurate with the onset of sudden events such as seizures, brain hypoxic events, and excursions of cerebral hypertension. Thus, we do not cover more static modalities such as imaging and biomarkers.

Recent studies highlight the potential of MMM to reduce variability in TBI outcomes associated with secondary insults. Integration of physiological variables-such as intracranial pressure, brain tissue oxygenation, arterial blood pressure, and electroencephalography-combined with artificial intelligence (AI) and advanced analytics, may enable earlier detection and prediction of adverse events. However, key challenges remain, including the need for larger harmonized datasets, standardized acquisition and interpretation methods, and prospective validation of multimodal-guided interventions. MMM is emerging as a cornerstone technology to enhance patient phenotyping in TBI, enabling more individualized and timely therapeutic interventions. Continued advances in data integration, analytics, and standardization will be essential to translate MMM from a promising research tool into a validated component of precision neurocritical care.