The diagnosis of traumatic brain injury is modernizing a new frame after 50 years

Advanced tools offer improved insights into the condition of the patients and their relaxation potential.

What is new: After more than half a century, the evaluation of traumatic brain injuries is revised.

Why it is important: Clinicers say that the proposed framework will lead to more precise diagnoses and treatment that support some patients strictly and prevent premature discussions about the decommissioning of life preservation in others.

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The trauma centers nationwide will begin to test a new approach to assessment of the traumatic brain injury (TBI), which is expected for more precise diagnoses and more appropriate treatment and the follow-up examination for patients.

The new framework, which was developed by a coalition of experts and patients from 14 countries and led by the National Institutes of Health, extends the evaluation beyond the immediate clinical symptoms. The additional criteria include biomarkers, CT and MRI scans as well as factors like other diseases and how the trauma has occurred.

The framework appears in the edition of May 20 of Lancet neurology.

For 51 years, trauma centers have used the Glasgow Coma scale to evaluate patients with TBI and to roughly divide them into light, moderate and heavy categories that are based exclusively at their level of consciousness and a handful of other clinical symptoms.

This diagnosis showed that the nursing patients were received in the emergency room and then. In severe cases, it also influenced the guidelines that doctors gave the families of the patients, including recommendations to remove life support. However, the doctors have long understood that these tests did not tell the whole story.

There are patients who were diagnosed with a concealment of the brain whose symptoms are released and do not receive follow-up because they are only a concussion and they live with weakening symptoms that destroy their quality of life. On the other hand, there are patients in whom “heavy” TBI was diagnosed and lived full life whose families had to consider to remove life -supporting treatment. “

Geoffrey Manley, Md, PhD, corresponding author, Professor of neurosurgery at UC San Francisco and member of the UCSF -Weill institute for neurosciences

In the United States, TBI led around 70,000 deaths in 2021 and made up about half a million permanent disabilities every year. Motor vehicle accidents, falls and assault are the most common causes.

New system better corresponds to patients with treatments

Known as CBI-M, the frame includes four column-clinical, biomarkers, imaging and modifier-which were developed by working groups by federal partners, TBI experts, scientists and patients.

“The proposed framework is a big step forward,” said co-senior author Michael McCrea, professor of neurosurgery and co-director of the Center for Neurotrauma Research at the Medical College of Wisconsin in Milwaukee. “We will be much better equipped to combine patients to form treatments that offer them the best chance of survival, recovery and the normal life function.”

The framework was cited by the NIH National Institute for Neurological Disorders and Strokes (NIH-Ninds), for which Manley, McCrea and its co-first and Co-Senior authors are members of the steering committee to improve the TBI characterization.

The clinical column keeps the total number of points of the Glasgow Coma scale as the central element of the evaluation and measures consciousness together with the pupil reactivity as a reference to the brain function. The frame recommends that the reactions of the scale to eye, verbal and motor commands or stimuli, presence of amnesia and symptoms such as headaches, dizziness and sensitivity to intoxication.

“This pillar should be the first priority in all patients,” said co-senior author Andrew Maas, MD, PhD, emeritus professor of neurosurgery at Antwerp University Hospital and the University of Antwerp, Belgium. “Investigations have shown that the elements of this pillar very much predict the severity of the injury and the patient result.”

Biomarker, imaging, modifiers offer critical information on recovery

The second pillar uses biomarkers that have been identified in blood tests to provide objective indicators for tissue damage and to overcome the limits of the clinical evaluation that can accidentally contain symptoms that are not connected to TBI.

Significantly, low mirrors of these biomarkers determine which patients do not need CT scans, which reduces unnecessary radiation exposure and health costs. These patients can then be released. In people with serious injuries, CT and MRI imaging – the third pillar of the scaffold – are important for the identification of blood clots, bleeding and lesions that indicate existing and future symptoms.

The biomarkers also identify the suitable patients in order to enroll in clinical studies to develop new TBI medication that have not been promoted in the past 30 years. A recently launched exam, which will be introduced nationwide at 18 trauma locations, can ultimately lead to new treatments.

“These biomarkers are of crucial importance in clinical studies,” said Manley. “In the past, we could not see the difference between a knock on the head and a TBI. Thanks to the biomarker, we can make this distinction and make sure that it is the TBI patient who registers for the attempt.”

The last pillar, modifiers, evaluates how the injury occurred, such as: It also includes existing diseases and medication, access to health care, former TBIs, drug abuse and living circumstances.

“This pillar summarizes the factors that research uses when we interpret a patient's clinical, blood biomaging and neuroimaging exams,” said Kristen-Dams-O'Connor, PHD, Professor of Rehabilitation and Human Performance, and the director of the brain cloth research center at the Icahn School of Medicine at Mount, in New York.

“An example is a patient with underlying cognitive impairment, who may need acute monitoring of the risk of clinical deterioration, regardless of the results for the initial clinical examination,” she said.

The proposed frame is introduced in trauma centers on a test basis. It is refined and validated before it is fully implemented.