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

Geoffrey T Manley¹, Kristen Dams-O'Connor², Michael L Alosco³, Hibah O Awwad⁴, Jeffery J Bazarian⁵, Peter Bragge⁶, John D Corrigan⁷, Adele Doperalski⁴, Adam R Ferguson⁸, Christine L Mac Donald⁹, David K Menon¹⁰, Molly M McNett¹¹, Joukje van der Naalt¹², Lindsay D Nelson¹³, Dana Pisică¹⁴, Noah D Silverberg¹⁵, Nsini Umoh⁴, Lindsay Wilson¹⁶, Esther L Yuh¹⁷, Henrik Zetterberg¹⁸, Andrew I R Maas¹⁹, Michael A McCrea¹³; NIH-NINDS TBI Classification and Nomenclature Initiative

Collaborators, Affiliations

Collaborators

NIH-NINDS TBI Classification and Nomenclature Initiative:
Rachel Syako Adams, Jennifer S Albrecht, David B Arciniegas, Breton M Asken, Ernest J Barthelemy, Mark Bayley, Thomas J Bayuk, Patrick Bellgowan, Shubhayu Bhattacharyay, Tricia Booker, David L Brody, Andras Buki, Heather Cameron, Lindsay Caron Epstein, Todd Cesar, Scott A Cota, Jill Daugherty, John Del Cecato, Bradley A Dengler, Ramon Diaz-Arrastia, Alicia Diggs, Maureen Dobbins, Ann-Christine Duhaime, Brian L Edlow, Ari Ercole, Anthony Figaji, Sarah N Fontaine, Guoyi Gao, Raquel C Gardner, Jessica Gill, Christopher C Giza, Juliet Haarbauer-Krupa, Scott Hamilton, Sidney Hinds, Lyn Jakeman, Shannon B Juengst, Inga K Koerte, Frederick K Korley, Walter Koroshetz, Rachel Lazarus, Fiona Lecky, Anthony H Lequerica, Lucia M Li, Rebekah Mannix, Stephanie Maxfield Panker, Andrew R Mayer, Gary McKinney, Timothy B Meier, Ana Mikolic, ACate Miller, Stefania Mondello, Kasey E Moritz, Pratik Mukherjee, Risa Nakase-Richardson, Virginia F J Newcombe, David O Okonkwo, Linda Papa, Monique R Pappadis, Corrine Peek-Asa, J B Phillips, Jennie Ponsford, Jussi P Posti, Ava M Puccio, Claudia S Roberston, Maya Sapiurka, Lindsay Simpson, Stephanie Sloley, Ewout Steyerberg, James Sulzer, Dwayne L Taliaferro, Olli Tenovuo, Danny G Thomas, Charlene Thomas, Abel Torres-Espin, Spyridoula Tsetsou, Alexis F Turgeon, Nancy Tuvesson, Eve Valera, Thijs Vande Vyvere, Claudio Villalobos Dintrans, Kevin K Wang, Melanie Wienhoven, Elisabeth A Wilde, Yu-Chien Wu, Keith Owen Yeates, John K Yue, Deborah Yurgelun-Todd

Affiliations

¹ Neurological Surgery, University of California, San Francisco, CA, USA. Electronic address: manleyg@ucsf.edu.
² Department of Rehabilitation and Human Performance and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
⁴ Division of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
⁵ Department of Emergency Medicine, Department of Neurology, and Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
⁶ Monash Sustainable Development Institute and BehaviourWorks Australia, Monash University, Melbourne, VIC, Australia.
⁷ Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA.
⁸ Neurological Surgery, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
⁹ Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA.
¹⁰ Department of Medicine, University of Cambridge, Cambridge, UK.
¹¹ College of Nursing, Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, The Ohio State University, Columbus, OH, USA.
¹² University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
¹³ Department of Neurosurgery and Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁴ Department of Public Health and Department of Neurosurgery, Erasmus MC-University Medical Center, Rotterdam, Netherlands.
¹⁵ Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.
¹⁶ Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK.
¹⁷ Department of Radiology and Biological Imaging, University of California San Francisco, San Francisco, CA, USA.
¹⁸ Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
¹⁹ Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.

PMID: 40409315
DOI: 10.1016/S1474-4422(25)00154-1

Review

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

Geoffrey T Manley et al. Lancet Neurol. 2025 Jun.

. 2025 Jun;24(6):512-523.

doi: 10.1016/S1474-4422(25)00154-1.

Authors

Collaborators

NIH-NINDS TBI Classification and Nomenclature Initiative:
Rachel Syako Adams, Jennifer S Albrecht, David B Arciniegas, Breton M Asken, Ernest J Barthelemy, Mark Bayley, Thomas J Bayuk, Patrick Bellgowan, Shubhayu Bhattacharyay, Tricia Booker, David L Brody, Andras Buki, Heather Cameron, Lindsay Caron Epstein, Todd Cesar, Scott A Cota, Jill Daugherty, John Del Cecato, Bradley A Dengler, Ramon Diaz-Arrastia, Alicia Diggs, Maureen Dobbins, Ann-Christine Duhaime, Brian L Edlow, Ari Ercole, Anthony Figaji, Sarah N Fontaine, Guoyi Gao, Raquel C Gardner, Jessica Gill, Christopher C Giza, Juliet Haarbauer-Krupa, Scott Hamilton, Sidney Hinds, Lyn Jakeman, Shannon B Juengst, Inga K Koerte, Frederick K Korley, Walter Koroshetz, Rachel Lazarus, Fiona Lecky, Anthony H Lequerica, Lucia M Li, Rebekah Mannix, Stephanie Maxfield Panker, Andrew R Mayer, Gary McKinney, Timothy B Meier, Ana Mikolic, ACate Miller, Stefania Mondello, Kasey E Moritz, Pratik Mukherjee, Risa Nakase-Richardson, Virginia F J Newcombe, David O Okonkwo, Linda Papa, Monique R Pappadis, Corrine Peek-Asa, J B Phillips, Jennie Ponsford, Jussi P Posti, Ava M Puccio, Claudia S Roberston, Maya Sapiurka, Lindsay Simpson, Stephanie Sloley, Ewout Steyerberg, James Sulzer, Dwayne L Taliaferro, Olli Tenovuo, Danny G Thomas, Charlene Thomas, Abel Torres-Espin, Spyridoula Tsetsou, Alexis F Turgeon, Nancy Tuvesson, Eve Valera, Thijs Vande Vyvere, Claudio Villalobos Dintrans, Kevin K Wang, Melanie Wienhoven, Elisabeth A Wilde, Yu-Chien Wu, Keith Owen Yeates, John K Yue, Deborah Yurgelun-Todd

Affiliations

¹ Neurological Surgery, University of California, San Francisco, CA, USA. Electronic address: manleyg@ucsf.edu.
² Department of Rehabilitation and Human Performance and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
⁴ Division of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
⁵ Department of Emergency Medicine, Department of Neurology, and Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
⁶ Monash Sustainable Development Institute and BehaviourWorks Australia, Monash University, Melbourne, VIC, Australia.
⁷ Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA.
⁸ Neurological Surgery, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
⁹ Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA.
¹⁰ Department of Medicine, University of Cambridge, Cambridge, UK.
¹¹ College of Nursing, Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, The Ohio State University, Columbus, OH, USA.
¹² University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
¹³ Department of Neurosurgery and Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁴ Department of Public Health and Department of Neurosurgery, Erasmus MC-University Medical Center, Rotterdam, Netherlands.
¹⁵ Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.
¹⁶ Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK.
¹⁷ Department of Radiology and Biological Imaging, University of California San Francisco, San Francisco, CA, USA.
¹⁸ Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
¹⁹ Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.

PMID: 40409315
DOI: 10.1016/S1474-4422(25)00154-1

Abstract

The clinical severity of traumatic brain injury (TBI) is commonly classified according to the Glasgow Coma Scale (GCS) sum score as mild (13-15), moderate (9-12), or severe (3-8). A new approach is needed for characterising TBI more accurately. In 2022, the US National Institutes of Health-National Institute of Neurological Disorders and Stroke launched an international initiative to address this need, with a focus on the acute phase of injury. Six working groups of TBI experts, implementation scientists, people with lived experience, and federal partners were established, involving 94 participants from 14 countries. The proposed new framework for the characterisation of acute TBI incorporates four pillars: a clinical pillar (full GCS and pupillary reactivity); a biomarker pillar (blood-based measures); an imaging pillar (pathoanatomical measures); and a modifier pillar (features influencing clinical presentation and outcome; CBI-M). The CBI-M framework provides a multidimensional characterisation of TBI to inform individualised clinical management and to improve scientific rigor. Research priorities include validation of the CBI-M framework, evaluation of its applicability beyond the acute phase of TBI, and strategies for clinical implementation.

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Conflict of interest statement

Declaration of interests GTM received research funding from NINDS, the US Department of Defense, Abbott Laboratories, the National Football League Scientific Advisory Board, and is a member of the NIH-NINDS steering committee initiative for improved characterisation and nomenclature of TBI. KD-O’C received research funding from the National Institute on Disability, Independent Living, and Rehabilitation Research and the US Department of Defense; consulting fees from Tampa VA Research Foundation; and travel support to attend meetings from National Neurotrauma Society. MA received research support from NIH and Life Molecular Imaging. JJB received consulting fees from Abbott Laboratories. PB and JC received travel support from NINDS. AF received research funding from NINDS, the US Department of Defense, the US Department of Veterans Affairs, Wings for Life Foundation, Craig H Neilsen Foundation, and Noyce Foundation. CLMD received research support from NIH and the US Department of Defense and travel support from NIH. DM received research funding from UK Research and Innovation, the National Institute for Health and Care Research, the Ministry of Defence (UK), and Alzheimer's Research UK and consulting fees from Neurotrauma Sciences, Lantmannen, GlaxoSmithKline, PressuraNeuro, CSL Behring, and Invex. MMM received research funding from the National Institute on Aging, the US Department of Defense, the Patient Centered Outcomes Research Institute, and Dexcom and royalites from Elsevier. JvdN received travel support from NIH. LDN received research support from NINDS and consulting fees from Resolys Bio. DP received research funding from the European Commission Seventh Framework Program, the Hannelore Kohl Stiftung, OneMind, Integra LifeSciences, and NeuroTrauma Sciences. NDS received research funding from NIH, Canadian Institutes of Health Research, Canada Foundation for Innovation, WorkSafeBC, Ontario Brain Institute, and the US Department of Defense. LW received consulting fees from Neurotrauma Sciences, Novartis, Mass General Brigham, and Medical College of Wisconsin, and travel support from NIH. ELY received research grants from NIH and the US Department of Defense. HZ received research funding from the Swedish Research Council, the EU's Horizon Europe Research and Innovation Programme, Swedish State Support for Clinical Research, Alzheimer Drug Discovery Foundation, and the EU Joint Programme. AIRM received research funding from the European Commission Seventh Framework Program and consulting fees from NeuroTrauma Sciences, GryphonBio, and PressuraNeuro. MAM received research funding from NINDS, the US Department of Defense, Abbott Laboratories, National Football League Scientific Advisory Board, National Collegiate Athletic Association, and is a member of the NIH-NINDS steering committee initiative for improved characterisation and nomenclature of TBI. All other authors declare no competing interests.

Comment in

A New Multimodal Classification and Nomenclature System for Acute Traumatic Brain Injury From the NIH-NINDS.
Conklin J, Lev MH. Conklin J, et al. AJR Am J Roentgenol. 2025 Aug 20. doi: 10.2214/AJR.25.33684. Online ahead of print. AJR Am J Roentgenol. 2025. PMID: 40833229 No abstract available.

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

Collaborators

Affiliations

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

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Collaborators

Affiliations

Abstract

Conflict of interest statement

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