A proposed framework for assessing traumatic brain injury (TBI) adds blood tests, scans and patient history to the standard Glasgow Coma Scale.
The new CBI-M system builds on the Glasgow Coma Scale (GCS) – widely used to assess levels of consciousness after brain injury – by introducing three additional pillars to support more accurate diagnosis and treatment planning, particularly during the early stages of injury.
The four-part model was proposed in response to a 2022 call by the US National Institutes of Health–National Institute of Neurological Disorders and Stroke (NINDS) for a more detailed way to classify TBI.
The CBI-M framework includes:
Clinical pillar: assesses full GCS scores and pupil reactivity
Biomarker pillar: measures levels of proteins in the blood (GFAP, UCH-L1 or S100B), released when brain cells are damaged
Imaging pillar: uses CT or MRI scans to identify damage within the skull
Modifier pillar: considers additional factors such as pre-existing health conditions or the nature of the injury
The authors wrote: “The CBI-M framework provides a multidimensional characterisation of TBI to inform individualised clinical management and to improve scientific rigour.
“Research priorities include validation of the CBI-M framework, evaluation of its applicability beyond the acute phase of TBI, and strategies for clinical implementation.”
While the model introduces new assessment elements, it retains the Glasgow Coma Scale as the foundation.
Co-author Andrew Maas, of Antwerp University Hospital said: “This pillar should be assessed as first priority in all patients.
“Research has shown that the elements of this pillar are highly predictive of injury severity and patient outcome.”
The framework is intended for use with all patients presenting with TBI, with the order of assessment adapted according to clinical condition and available resources.
It may also support better decision-making on treatment approaches, including discussions around life support in serious cases.
