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Assessing the Severity of Traumatic Brain Injury—Time for a Change?

Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, 20521 Turku, Finland
Department of Neurology, Institute of Clinical Medicine, University of Turku, 20500 Turku, Finland
3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; [email protected]
Alzheimer's Disease Research Center, College of Engineering, Boston University School of Medicine, Boston, MA 02118, USA
Clinical, cognitive and computational neuroimaging laboratory (C3NL), Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, W12 0NN UK
Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
Concussion Care Centre of Virginia and Tree of Life, Richmond, VA 23233, USA
Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(1), 148;
Received: 5 December 2020 / Revised: 23 December 2020 / Accepted: 30 December 2020 / Published: 4 January 2021
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current classifications are primarily based on clinical evaluations, which are non-specific and poorly predictive of long-term disability. Brain imaging results have also been used, yet there are multiple ways of doing brain imaging, at different timepoints in this very dynamic injury. Severity itself is a vague concept. All prediction models based on combining variables that can be assessed during the acute phase have reached only modest predictive values for later outcome. Yet, these early labels of severity often determine how the patient is treated by the healthcare system at large. This opinion paper examines the problems and provides caveats regarding the use of current severity labels and the many practical and scientific issues that arise from doing so. The objective of this paper is to show the causes and consequences of current practice and propose a new approach based on risk classification. A new approach based on multimodal quantifiable data (including imaging and biomarkers) and risk-labels would be of benefit both for the patients and for TBI clinical research and should be a priority for international efforts in the field. View Full-Text
Keywords: traumatic brain injury; severity; assessment; outcome traumatic brain injury; severity; assessment; outcome
MDPI and ACS Style

Tenovuo, O.; Diaz-Arrastia, R.; Goldstein, L.E.; Sharp, D.J.; van der Naalt, J.; Zasler, N.D. Assessing the Severity of Traumatic Brain Injury—Time for a Change? J. Clin. Med. 2021, 10, 148.

AMA Style

Tenovuo O, Diaz-Arrastia R, Goldstein LE, Sharp DJ, van der Naalt J, Zasler ND. Assessing the Severity of Traumatic Brain Injury—Time for a Change? Journal of Clinical Medicine. 2021; 10(1):148.

Chicago/Turabian Style

Tenovuo, Olli, Ramon Diaz-Arrastia, Lee E. Goldstein, David J. Sharp, Joukje van der Naalt, and Nathan D. Zasler. 2021. "Assessing the Severity of Traumatic Brain Injury—Time for a Change?" Journal of Clinical Medicine 10, no. 1: 148.

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