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"Mild, Moderate, Severe" No More: A New Way to Classify Traumatic Brain Injuries (TBIs)

Updated: 6 hours ago

TL;DR – A new traumatic brain injury (TBI) framework is being trialed in trauma centers. Stepping away from the mild/moderate/severe categorization of TBI, the new CBI-M Framework focuses on four pillars – clinical, biomarker, imaging, and modifiers – with the goal of better capturing the condition, recovery, and lived experiences of those living with TBI.


The problem: An outdated system


For years we have characterized traumatic brain injuries as mild, moderate, or severe. These simplified categories are based largely on the Glasgow Coma Scale (GCS), a 15-point scale that measures a patient's level of consciousness in the acute TBI phase via responses to stimuli and classifies a patient's sum score as mild (13–15), moderate (9–12), or severe (3–8).


Many medical professionals have expressed concern that this classification system no longer serves the brain injury community, calling it inaccurate, outdated, and often failing to meet the needs of those affected by traumatic brain injury (BIAA, 2025). For example, the misleading language of "mild" suggests that the injury is insignificant or not a concern for long-term consequences, which we know is not representative of the lived experiences of many who have endured a concussion/mild TBI. Additionally, the current classification system does not include findings from objective data (like blood-based biomarkers and imaging) or consider factors that influence recovery trajectory or long-term outcomes.


The solution: A more comprehensive framework from TBI experts


In 2022, the National Institutes of Health (NIH) launched an international initiative to address the need for a more accurate and evidence-based classification system for TBI.


In January 2024, over 100 TBI experts, researchers, and patients gathered in Bethesda, MD at the National Institute of Neurological Disorders and Stroke (NINDS) 2024 Traumatic Brain Injury Classification and Nomenclature Workshop. The result of the two-day workshop was the new CBI-M Model.


The CBI-M Model


The CBI-M framework has four key pillars: clinical, biomarker, Imaging, and modifiers.


  • Clinical: The clinical pillar looks at a person's level of consciousness and response to eye, verbal, and motor commands via the Glasgow Coma Scale (GCS), in addition to pupillary reactivity and symptoms such as headaches, dizziness, and amnesia.

  • Biomarker: The biomarker pillar uses blood biomarkers via blood test to look at tissue damage and determine if imaging is recommended.

  • Imaging: The imaging pillar focuses on using CT and MRI scans to identify patients with more severe injuries including blood clots, bleeding, and lesions.

  • Modifiers: The modifiers pillar focuses on how the injury occurred and many factors that affect a person's present and future symptoms, including any pre-existing conditions, history of TBI, substance use, healthcare access, etc.


The new CBI-M Framework for TBI classification is meant to better capture the full spectrum of the injury, supporting better diagnosis, treatment, and understanding of long-term outcomes.


According to BIAA and Mount Sinai, the CBI-M framework is currently being trialed in select trauma centers and will undergo ongoing evaluation and validation before full implementation. 


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Let's help each other stay up-to-date on the latest concussion research! Share this exciting update with the parents, coaches, and medical professionals in your life.



Questions about concussion management or the role of the SLP in concussion care? Reach out to jenny@cognitiveslp.com or join the waitlist for our next Concussion Education Series below!


Jenny Traver, MS, CCC-SLP, CBIS


References:

Brain Injury Association of America (BIAA). New TBI Classification System Announced. Brain Injury Association of America. 20 May 2025 https://biausa.org/public-affairs/public-awareness/news/new-tbi-classification-system-announced


Mount Sinai. New Framework for Characterizing Traumatic Brain Injury to Reveal More Detail about Patient’s Condition and Potential for Recovery. Mount Sinai Health System, 23 May 2025, www.mountsinai.org/about/newsroom/2025/new-framework-for-characterizing-traumatic-brain-injury-to-reveal-more-detail-about-patients-condition-and-potential-for-recovery 


Manley, G. T., Dams-O’Connor, K., Alosco, M. L., Awwad, H. O., Bazarian, J. J., Bragge, P., ... & Yurgelun-Todd, D. (2025). A new characterisation of acute traumatic brain injury: the NIH-NINDS TBI Classification and Nomenclature Initiative. The Lancet Neurology, 24(6), 512-523. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00154-1/abstract


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