Background and Need for Change
- Traumatic brain injury (TBI) has traditionally been classified as mild, moderate, or severe using the Glasgow Coma Scale (GCS) alone.
- This unimodal approach is limited: it overlooks the complexity and continuum of TBI, ignores other diagnostic data, and can lead to stigma, misclassification, and suboptimal care.
- Patients and clinicians have expressed concerns that the current system fails to capture the true impact and diversity of TBI presentations.
Development of the CBI-M Framework
- In response, the NIH-NINDS led an international initiative (2022–2025) involving 94 experts from 14 countries, including people with lived experience, to develop a new, multidimensional classification system for acute TBI.
- Six working groups addressed clinical assessment, biomarkers, imaging, psychosocial/environmental modifiers, retrospective identification, and implementation strategies.
Overview of the CBI-M Framework
- The new framework is called CBI-M, standing for Clinical, Biomarker, Imaging, and Modifier pillars.
- Each pillar has basic (core) and expanded (context-specific) components, allowing flexibility and adaptability to different settings.
CBI-M Pillars: Detailed Breakdown
1. Clinical Pillar
Core Elements:- Glasgow Coma Scale (GCS) total and component scores (eye, verbal, motor responses).
- Pupillary reactivity (both reactive, one reactive, none reactive).
- Assessment of post-traumatic amnesia.
- Documentation of signs and symptoms (e.g., headache, dizziness, noise sensitivity) using validated scales.
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