CBI-M, A New TBI Classification with 4 Pillars

Move over Glasgow Coma Score! A new framework for the characterization of acute TBI has been proposed for the acute stage of injury

FOUR PILLARS

1. A clinical pillar

   1. Full GCS

   2. Pupillary reactivity

2. A biomarker pillar (blood-based measures)

   1. Glial fibrillary acidic protein (GFAP)

   2. Ubiquitin C-terminal hydrolase L1 (UCH-L1)

   3. S100 calcium-binding protein B (S100B)

3. An imaging pillar (pathoanatomical measures)

   1. CT

   2. MRI

4. A modifier pillar

   1. Injury factors

   2. Patient Factors

   3. Community and society factors

Of particular interest:

The term traumatic axonal or microvascular injury was proposed by the imaging working group to replace traumatic axonal injury and diffuse axonal injury, which are typically seen on acute CT or MRI scans. This change in nomenclature is based on the finding that axonal and microvascular lesions often occur in the same locations, and might be difficult or impossible to distinguish on an acute brain CT scan.

Citation:

A new characterisation of acute traumatic brain injury: the NIH-NINDS TBI Classification and Nomenclature Initiative

Manley, Geoffrey TAdams, Rachel Syako et al.

The Lancet Neurology, Volume 24, Issue 6, 512 - 523