Marking a new age in characterization of acute traumatic brain injury: The NINDS TBI classification and nomenclature initiative

New Rochelle, NY, May 21st, 2025—In collaboration with the Journal of Neurotrauma and The Lancet, these papers introduce a transformative shift in the way traumatic brain injury (TBI) is classified and understood. Traditionally, TBI severity has been determined using the Glasgow Coma Scale (GCS), categorizing cases as mild, moderate, or severe. However, this method fails to capture the complexity of brain injury. In response, the U.S. National Institutes of Health–National Institute of Neurological Disorders and Stroke initiated a global effort in 2022 to develop a more nuanced framework, particularly focused on the acute phase of TBI.

This initiative convened six multidisciplinary working groups—comprising 94 experts from 14 countries, including clinicians, researchers, individuals with lived experience, and policy partners. Together, they proposed the Characterization of Brain Injury with Modifiers (CBI-M) framework, structured around four key pillars: clinical assessments (GCS and pupillary reactivity), blood-based biomarkers, neuroimaging findings, and outcome-modifying factors. This multidimensional approach aims to enhance personalized care, improve the precision of research, and guide future implementation and validation efforts.

Highlights from the collection include:
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

• Menon et al.

David Menon, from the University of Cambridge, and coauthors, describe the CSWG as being primarily focused on the acute clinical assessment of TBI in hospital settings.

“The CSWG concluded that the Glasgow Coma Scale (GSC) remains central to TBI characterization, but must include detailed scoring of eye, verbal, and motor components, with identification of confounding factors and clear documentation of non-assessable components,” state the authors. “Pupillary reactivity should be documented in all patients, but recorded separately from the GSC, rather than as an integrated GSC-Pupils score.”  Read the article here

Retrospective Identification and Characterization of Traumatic Brain Injury—Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Retrospective Classification Working Group

• Corrigan et al.

John Corrigan, PhD, from The Ohio State University, and coauthors, concluded that the description of past TBIs should be based on the method of detection employed. The authors examined five types of methodologies for identifying past TBIs: self/proxy-report, medical record extraction, imaging, fluid-based biomarkers, and performance-based biomarkers.

They concluded that “self/proxy-report is essential for clinical, research and surveillance applications, providing information that cannot be obtained via other methods.”
Read the article here

Blood-Based Biomarkers for Improved Characterization of Traumatic Brain Injury: Recommendations from the 2024 National Institute for Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Blood-Based Biomarkers Working Group

• Bazarian et al.

Jeffrey Bazarian, from the University of Rochester School of Medicine and Dentistry, and coauthors, report that, “Current evidence supports the use of glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1) and S100B calcium binding protein (S100B) to assist in re-classification of TBI at acute time points (0-24 hours) primarily in ED settings, while neurofilament light chain (NfL), GFAP and S100B have utility at subacute time point (1-30 days) in hospital and ICU settings.”

“Blood levels of these biomarkers reflect the extent of structural brain injury in TBI and may be useful for describing the extent of structural brain injury in a classification system,” state the investigators. Read the article here

Other important papers in this special issue include:

• Neuroimaging Characterization of Acute Traumatic Brain Injury with Focus on Frontline Clinicians: Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Imaging Working Group

Mac Donald et al.

• Marking a New Age in Characterization of Acute Traumatic Brain Injury: The National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative

Manley et al.

• Starting with the End in Mind: Recommendations to Optimize Implementation of a Novel TBI Classification from the 2024 NINDS TBI Classification and Nomenclature Workshop’s Knowledge to Practice Working Group

Bragge et al.

These articles will be published together in a forthcoming special issue of the Journal of Neurotrauma (July 2025).

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