Cited by 1,141Traumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury ResearchAutomotive and Human Injury Biomechanics

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Classification of Traumatic Brain Injury for Targeted Therapies

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Saatman, Kathryn E., Duhaime, Ann-Christine, Bullock, Ross, Maas, Andrew I.R., Valadka, Alex, Manley, Geoffrey T.·2008·Journal of Neurotrauma

DOI 10.1089/neu.2008.0586PMC PMC2721779

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Abstract

The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.

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Authors: Saatman, K. E., Duhaime, A.-C., Bullock, R., Maas, A. I. R., Valadka, A., & Manley, G. T.
Affiliations: University of Kentucky (US)
Dartmouth–Hitchcock Medical Center (US)
University of Miami (US)
University of Antwerp (BE)
The University of Texas Health Science Center at Houston (US)
University of California, San Francisco (US)
Corresponding author: Manley, Geoffrey T.
ORCID: Duhaime, Ann-Christine
Maas, Andrew I.R.
Valadka, Alex
Manley, Geoffrey T.
Venue: Journal of Neurotrauma
Publisher: SAGE Publications
Published: 2008-07
Volume: 25
Issue: 7
Pages: 719-738
ISSN: 0897-7151 (ISSN-L)
1557-9042
DOI: 10.1089/neu.2008.0586
PMC: PMC2721779
OpenAlex: W2050800676
Cited by: 1,141
References: 70
Citations by year: 2026: 25 · 2025: 62 · 2024: 63 · 2023: 45 · 2022: 57 · 2021: 63 · 2020: 74 · 2019: 69 · 2018: 87 · 2017: 79 · 2016: 64 · 2015: 102 · 2014: 59 · 2013: 62 · 2012: 70
FWCI: 32.85
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Journal of Neurotrauma (publishedVersion, cc-by)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
Funders: National Institute on Disability and Rehabilitation Research
National Institute of Neurological Disorders and Stroke (P01NS038660, R01NS042691, R01NS050173, P01NS058484, R01NS045131)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD045364)
Topics: Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Physical Sciences › Engineering › Biomedical Engineering › Automotive and Human Injury Biomechanics
Keywords: traumatic brain injury, targeted therapy, pathophysiological mechanisms, Glasgow Coma Scale, clinical trial design, patient selection criteria, patient stratification, prognostic model, preclinical models, outcome measurement, neurovascular injury
MeSH terms: Animals, Brain Injuries, Clinical Trials as Topic, Data Interpretation, Statistical, Diagnosis, Differential, Diagnostic Imaging, Disability Evaluation, Disease Models, Animal, Humans, Trauma Severity Indices, Glasgow Coma Scale, Endpoint Determination

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Classification of Traumatic Brain Injury for Targeted Therapies

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