| Title |
Beyond mild, moderate, and severe traumatic brain injury: modelling severity from clinical, neuroimaging, and blood-based indicators |
| Authors |
Nelson, Lindsay D ; Magnus, Brooke E ; Yue, John K ; Balsis, Steve ; Patrick, Christopher J ; Temkin, Nancy ; Yuh, Esther L ; Diaz-Arrastia, Ramon ; Ryu, Ehri ; Maas, Andrew I.R ; Menon, David K ; Wilson, Lindsay ; Manley, Geoffrey T |
| DOI |
10.1016/j.ebiom.2025.106001 |
| Full Text |
|
| Is Part of |
eBioMedicine.. Amsterdam : Elsevier. 2025, vol. 121, art. no. 106001, p. 1-20.. ISSN 2352-3964 |
| Keywords [eng] |
Blood-based biomarkers ; Classification ; Item response theory ; Neuroimaging ; Severity ; Traumatic brain injury |
| Abstract [eng] |
Background: The conventional clinical approach to characterising traumatic brain injuries (TBIs) as mild, moderate, or severe using the Glasgow Coma Scale (GCS) total score has well-known limitations, prompting calls for more sophisticated strategies. Methods: We used item response theory (IRT) to develop a new method for quantifying TBI severity using 24 clinical, head computed tomography, and blood-based biomarker variables familiar to clinicians and researchers. IRT uses individuals’ response patterns across indicators to estimate relationships between the indicators and a latent continuum of TBI severity. Model parameters were used to assign severity scores in two large cohorts, and associations with traditional GCS categories and 6-month functional outcomes (Glasgow Outcome Scale-Extended [GOSE]) were tested with correlational and logistic regression analyses. Findings: In the prospective Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort (N = 2545), modelling showed the 24 indicators index a common latent continuum of TBI severity. IRT enabled us to identify the relative contribution of these features to estimate an individual's TBI severity. Finally, within both the TRACK-TBI derivation sample and an external validation sample (Collaborative European NeuroTrauma Effectiveness Research in TBI [CENTER-TBI]), TBI severity scores generated using this novel IRT-based method incrementally predicted functional (GOSE) outcome better than classic clinical (mild, moderate, severe) or International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) classification methods. Interpretation: Our findings directly inform ongoing international efforts to refine and deploy new pragmatic, empirically-supported strategies for characterising TBI, while illustrating a strategy that may be useful to improve staging systems for other diseases. Funding: This secondary analysis project was funded by the U.S. National Institute of Neurological Disorders and Stroke (Grant No. R01 NS110856). |
| Published |
Amsterdam : Elsevier |
| Type |
Journal article |
| Language |
English |
| Publication date |
2025 |
| CC license |
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