Cited by 61Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesAutomotive and Human Injury Biomechanics

Blood-Based Biomarkers for Improved Characterization of Traumatic Brain Injury: Recommendations from the 2024 National Institute for Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Blood-Based Biomarkers Working Group

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Bazarian, Jeffrey J., Zetterberg, Henrik, Buki, András, Dengler, Bradley A., Diaz-Arrastia, Ramon, Korley, Frederick K., Lazarus, Rachel, Meier, Timothy B. +17 more·2025·Journal of Neurotrauma

Abstract

A 2022 report by the National Academies of Sciences, Engineering, and Medicine called for a Traumatic Brain Injury (TBI) Classification Workshop by the National Institutes of Health (NIH) to develop a more precise, evidence-based classification system. The workshop aimed to revise the Glasgow Coma Scale-based system by incorporating neuroimaging and validated blood biomarker tests. In December 2022, the National Institute for Neurological Disorders and Stroke formed six working groups of TBI experts to make recommendations for this revision. This report presents the findings and recommendations from the blood-based biomarker (BBM) working group, including feedback from the workshop and subsequent public review. The application of BBMs in a TBI classification system has potential to allow for a more adaptable and nuanced approach to triage, diagnosis, prognosis, and treatment. Current evidence supports the use of glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1, and S100B calcium-binding protein (S100B) to assist in reclassification of TBI at acute time points (0–24 h) primarily in emergency department settings, while neurofilament light chain (NfL), GFAP, and S100B have utility at subacute time points (1–30 days) in-hospital and intensive care unit settings. Blood levels of these biomarkers reflect the extent of structural brain injury in TBI and may be useful for describing the extent of structural brain injury in a classification system. While there is insufficient evidence to support a role for BBMs at chronic time points (>30 days), emerging evidence suggests that NfL and phosphorylated tau may have a potential future role in this regard. For inclusion in a revised TBI classification system, BBM assays must have appropriate age- and sex-specific reference ranges, be harmonized across platforms, and achieve high analytical precision, including accuracy, linearity, detection limits, selectivity, recovery, reproducibility, and stability. Improving transparency in BBM assay development can be achieved through large-scale data sharing of methods and results. Future research should focus on methods for promoting clinical adoption of BBM results, correlating BBMs with advanced neuroimaging, and on discovering new biomarkers for improved diagnosis and prognosis.

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  • The NINDS TBI Classification and Nomenclature Workshop yielded recommendations to expand TBI classification to include additional clinical assessments, neuroimaging, blood-based biomarkers and psychological and environmental modifiers.

    “The workshop yielded recommendations to expand TBI classification to include additional clinical assessments, neuroimaging, blood-based biomarkers and psychological and environmental modifiers (Bazarian et al., 2025; Bragge et al., 2025; Corrigan et al., 2025; Mac Donald et al., 2025; Manley et al., 2025; Menon et al., 2025; Nelson et al., 2025).”

    From Evaluating cognitive performance using the National Institutes of Health Toolbox Cognitive Battery in children with traumatic brain injury (2025) · cites this paper as Bazarian et al., 2025

    The Abstract and Overview of Literature and Current State describe recommendations to incorporate blood-based biomarkers into a revised TBI classification system, alongside neuroimaging. This paper reports the blood-based biomarker working group’s recommendations; the passages do not support the sentence’s additional claim about psychological and environmental modifiers. (LLM, conf=0.86)

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Research works printed but not linked: 8

  1. [2]National Academies of Sciences E, Medicine, Health. Copyright 2022 by the National Academy of Sciences. All rights reserved. In: (Matney C, Bowman K, Berwick D, eds). Traumatic Brain Injury: A Roadmap for Accelerating Progress. National Academies Press (US); 2022. 35533242
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Authors
Bazarian, J. J., Zetterberg, H., Buki, A., Dengler, B. A., Diaz-Arrastia, R., Korley, F. K., Lazarus, R., Meier, T. B., Mondello, S., Moritz, K., Okonkwo, D. O., Papa, L., Phillips, J. B., Posti, J. P., Puccio, A. M., Sloley, S., Steyerberg, E., Wang, K. K., Awwad, H. O., Dams-O’Connor, K., Doperalski, A., Maas, A. I. R., McCrea, M. A., Umoh, N., & Manley, G. T.
Affiliations
  • University of Rochester Medicine (US)
  • University of Gothenburg (SE)
  • Örebro University, Örebro, Sweden.
  • Uniformed Services University of the Health Sciences (US)
  • University of Pennsylvania (US)
  • University of Michigan (US)
  • AARP (US)
  • Medical College of Wisconsin (US)
  • University of Messina (IT)
  • United States Army Medical Research and Development Command (US)
  • University of Pittsburgh (US)
  • Orlando Health (US)
  • University of Turku (FI)
  • Defense Health Agency (US)
  • Leiden University (NL)
  • Atlanta VA Health Care System (US)
  • National Institute of Neurological Disorders and Stroke (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • University of Antwerp (BE)
  • University of California, San Francisco (US)
Corresponding author
Bazarian, Jeffrey J.
Venue
Journal of Neurotrauma
Published
2025-07
Volume
42
Issue
13-14
Pages
1065-1085
ISSN
  • 0897-7151 (ISSN-L)
  • 1557-9042
OpenAlex
W4410530471
Cited by
61
References
133
Citations by year
2026: 49 · 2025: 12
FWCI
42.28
Type
journal article
Language
en
Open access
Locations
  • Journal of Neurotrauma (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
Funders
National Institute of Neurological Disorders and Stroke (U01NS131740)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Automotive and Human Injury Biomechanics
Keywords
traumatic brain injury, blood-based biomarkers, neurofilament light chain, glial fibrillary acidic protein, S100B, UCHL1, phosphorylated tau, reference values, neuroimaging correlation, prognosis
MeSH terms
Brain Injuries, Traumatic, Humans, United States, Biomarkers, National Institute of Neurological Disorders and Stroke (U.S.)

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