A Paradigm Shift in Brain Injury Care
By Thomas Lehrich, President of the Board, Plus One Foundation
Traumatic Brain Injury (TBI) remains one of the most challenging and medical conditions treated in trauma centers today.
Recognizing the complexity and long-term impact of TBIs, trauma centers across the nation are implementing a new, comprehensive approach to assessing TBIs. It is a framework that moves beyond traditional measurement tools to capture a fuller picture of brain injury and optimize outcomes.
Change
For more than five decades, the Glasgow Coma Scale (GCS) has been the cornerstone of TBI assessment in emergency and trauma settings. While revolutionary in its time, the GCS categorizes injury based on eye, verbal, and motor responses.
Recognizing GCS had limitations a coalition of experts, clinicians, and researchers collaborated with the National Institutes of Health (NIH) to design a more holistic model known as CBI-M.
This framework reflects the latest brain injury science and expands traditional assessment practices by incorporating four pillars:
Clinical: Retains the core strengths of the Glasgow Coma Scale while broadening symptom evaluation to include amnesia, dizziness, headache severity, and other indicators of neurological dysfunction.
Biomarkers: Utilizes objective blood-based markers of brain injury to complement clinical findings, helping detect subtle structural damage that might be missed in early assessment.
Imaging: Advances in CT, MRI, and potentially future imaging modalities provide detailed views of brain structures, identifying contusions, microbleeds, and diffuse injury patterns that influence management decisions.
Modifiers: Considers patient-specific factors — including age, pre-existing conditions, mechanism of injury, and other contextual elements — that affect both immediate presentation and long-term recovery.
By uniting these pillars, the CBI-M framework offers clinicians a multidimensional profile of injury severity, enabling more precise triage and tailored care.
What This Means for Trauma Centers
The adoption of these expanded TBI assessment protocols represents a significant evolution in trauma care. Instead of relying solely on consciousness level at presentation, providers now have tools to:
Stratify patients more accurately, reducing under-triage and ensuring that subtle but serious injuries are not overlooked.
Tailor early interventions, including decisions about neurosurgical consultation, monitoring intensity, and rehabilitation planning.
Improve communication among multidisciplinary trauma teams by standardizing how injury severity is defined and shared.
While ongoing research continues to refine the role of biomarkers and advanced imaging in acute care, early adoption of the CBI-M framework across pilot trauma centers highlights a growing consensus:
Education and the Think aBout It Program
Alongside clinical innovation, education remains central to improving outcomes for individuals affected by TBI. The Think aBout It educational program, developed by the Plus One Foundation, seeks to bridge gaps in public understanding and clinical knowledge by highlighting emerging research and practical insights into neurological health — including expanded TBI assessment protocols.
Looking Ahead
As trauma centers continue to evaluate and refine these updated protocols, the healthcare community moves closer to a future where TBI assessment is less about assigning a category and more about understanding a patient’s unique neurobiological profile. This evolution promises not only improved acute care, but also more effective long-term strategies for rehabilitation, recovery, and quality of life following brain injury.
Thomas Lehrich