Traumatic Brain Injury classification - a move from GCS to CBI-M?

A coalition of experts from 14 countries including the UK has been considering a new way to evaluate Traumatic Brain Injury (TBI) patients with the aim of leading to more accurate diagnoses and appropriate treatment plans.

The Glasgow Coma Score (GCS), used since 1974, is a 15-point scale measuring a patient’s visual, verbal and motor responsiveness leading to a TBI being defined as mild, moderate or severe. Given the clinical and technical developments over the last 50 years GCS is seen as being outdated and overly simplistic as it often does not mirror the ongoing cognitive function of patients.

A new framework for the characterisation of TBI is proposed which aims at looking beyond the immediate clinical symptoms to manage TBI as a condition with acute and long-term phases. The proposed new framework – CBI-M – consists of four pillars:

• Clinical assessment: the GCS score will remain part of the clinical assessment together with pupillary reactivity.
• Blood-based biomarker testing: to provide objective measures of brain injury severity.
• Imaging: CT and MRI imaging to identify bleeding, blood clots, lesions and skull fractures.
• Modifiers: an assessment of how the injury occurred, pre-existing conditions, a prior TBI, substance abuse and any relevant social circumstances that could affect the patient’s outcome

Experts predict the CBI-M framework will improve survival rates, reduce disability and allow for a more personalised approach to TBI management. It is anticipated that the new framework will lead to better predictions of long-term outcomes and assist in rehabilitation planning and resource allocation.

For a patient, it will offer a more precise and holistic view of TBI supporting better treatment decisions and more accurate prognoses.

The CBI-M framework has been phased in at American trauma clinics on a trial basis so that it can be refined and validated before a full implementation can be rolled out across the USA. No changes are planned yet in the UK, so for now the GCS remains the primary TBI classification scheme. However, if the CBI-M framework is accepted in the US then it is likely that changes will follow in the UK.