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Classification of Traumatic Brain Injury for Targeted Therapies
Open accessAbstract
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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“The secondary insult (ie, secondary damage, nonmechanical damage), characterizes consecutive neuropathological processes initiated at the moment of injury with delayed clinical presentation.For example, intracranial hypertension, hypoxia, hyponatremia, and cerebral ischemia refer to secondary insults, and these types of injury are variably sensitive to therapeutic interventions (94,97,111).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [111]
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“This strategy presents additional challenges as each animal model reflects a specific type of TBI and does not fully recapitulate primary and secondary damage evident in human TBI (45) resulting in restricted translation (46).”
From The Inflammatory Continuum of Traumatic Brain Injury and Alzheimer’s Disease (2018) · cites this paper as [45]
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Metadata
- 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.
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2008-07
- Volume
- 25
- Issue
- 7
- Pages
- 719-738
- ISSN
- 0897-7151 (ISSN-L)
- 1557-9042
- 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
- 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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