| 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.; Grandhi, Ramesh; Keene, C. Dirk; Madden, Christopher; McCrea, Michael; Merchant, Randall; Mukherjee, Pratik; Ngwenya, Laura B.; Puccio, Ava; Robertson, Claudia; Schnyer, David; Taylor, Sabrina R.; Vassar, Mary; Ackerlund, Cecilia; Adams, Hadie; Amrein, Krisztina; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Antoni, Anna; Audibert, Gérard; Azouvi, Philippe; Azzolini, Maria Luisa; Bartels, Ronald; Barzó, Pál; Beauvais, Romuald; Beer, Ronny; Bellander, Bo-Michael; Belli, Antonio; Benali, Habib; Berardino, Maurizio; Beretta, Luigi; Blaabjerg, Morten; Bragge, Peter; Brazinova, Alexandra; Brinck, Vibeke; Brooker, Joanne; Brorsson, Camilla; Buki, Andras; Bullinger, Monika; Cabeleira, Manuel; Caccioppola, Alessio; Calappi, Emiliana; Calvi, Maria Rosa; Cameron, Peter; Lozano, Guillermo Carbayo; Carbonara, Marco; Castaño-León, Ana M.; Cavallo, Simona; Chevallard, Giorgio; Chieregato, Arturo; Citerio, Giuseppe; Clusmann, Hans; Coburn, Mark Steven; Coles, Jonathan; Cooper, Jamie D.; Correia, Marta; Čović, Amra; Curry, Nicola; Czeiter, Endre; Czosnyka, Marek; Dahyot-Fizelier, Claire; Dark, Paul; Dawes, Helen; De Keyser, Véronique; Degos, Vincent; Della Corte, Francesco; Boogert, Hugo den; Depreitere, Bart; Đilvesi, Đula; Dixit, Abhishek; Donoghue, Emma; Dreier, Jens; Dulière, Guy-Loup; Ercole, Ari; Esser, Patrick; Ezer, Erzsébet; Fabricius, Martin; Feigin, Valery L.; Foks, Kelly; Frisvold, Shirin; Furmanov, Alex; Gagliardo, Pablo; Galanaud, Damien; Gantner, Dashiell; Gao, Guoyi; George, Pradeep; Ghuysen, Alexandre; Giga, Lelde; Glocker, Ben; Golubović, Jagoš; Gomez, Pedro A.; Gratz, Johannes; Gravesteijn, Benjamin; Grossi, Francesca; Gruen, Russell L.; Gupta, Deepak; Haagsma, Juanita A.; Haitsma, Iain; Helbok, Raimund; Helseth, Eirik; Horton, Lindsay; Huijben, Jilske; Hutchinson, Peter J.; Jacobs, Bram; Jankowski, Stefan; Jarrett, Mike; Jiang, Ji-yao; Johnson, Faye; Jones, Kelly; Kals, Mart; Karan, Mladen; Kolias, Angelos G.; Kompanje, Erwin; Kondziella, Daniel; Koskinen, Lars-Owe; Kovács, Noémi; Kowark, Ana; Lagares, Alfonso; Lanyon, Linda; Laureys, Steven; Lecky, Fiona; Ledoux, Didier; Lefering, Rolf; Legrand, Valerie; Lejeune, Aurelie; Levi, Leon; Lightfoot, Roger; Lingsma, Hester; Maegele, Marc; Majdan, Marek; Manara, Alex; Maréchal, Hugues; Martino, Costanza; Mattern, Julia; McFadyen, Charles; McMahon, Catherine; Melegh, Béla; Menovsky, Tomas; Mikolic, Ana; Misset, Benoit; Muraleedharan, Visakh; Murray, Lynnette; Negru, Ancuta; Nelson, David; Newcombe, Virginia; Nieboer, Daan; Nyirádi, József; Oresic, Matej; Ortolano, Fabrizio; Otesile, Olubukola; Palotie, Aarno; Parizel, Paul M.; Payen, Jean-François; Perera, Natascha; Perlbarg, Vincent; Persona, Paolo; Peul, Wilco; Piippo-Karjalainen, Anna; Pirinen, Matti; Pisica, Dana; Ples, Horia; Polinder, Suzanne; Pomposo, Inigo; Posti, Jussi P.; Puybasset, Louis; Rădoi, Andreea; Ragauskas, Arminas; Raj, Rahul; Rambadagalla, Malinka; Rehorčíková, Veronika; Helmrich, Isabel Retel; Rhodes, Jonathan; Richardson, Sylvia; Richter, Sophie; Ripatti, Samuli; Rocka, Saulius; Roe, Cecilie; Roise, Olav; Rosenfeld, Jeffrey; Rosenlund, Christina; Rosenthal, Guy; Rossaint, Rolf; Rossi, Sandra; Rueckert, Daniel; Rusnák, Martin; Sahuquillo, Juan; Sakowitz, Oliver; Sanchez-Porras, Renan; Sandor, Janos; Schäfer, Nadine; Schmidt, Silke; Schoechl, Herbert; Schoonman, Guus; Schou, Rico Frederik; Schwendenwein, Elisabeth; Sewalt, Charlie; Singh, Ranjit D.; Skandsen, Toril; Smielewski, Peter; Sorinola, Abayomi; Stamatakis, Emmanuel; Stanworth, Simon; Stevens, Robert; Stewart, William; Steyerberg, Ewout W.; Stocchetti, Nino; Sundström, Nina; Takala, Riikka; Tamás, Viktória; Tamosuitis, Tomas; Taylor, Mark Steven; Ao, Braden Te; Tenovuo, Olli; Theadom, Alice; Thibaut, Aurore; Thomas, Matt; Tibboel, Dick; Timmers, Marjolijn; Tolias, Christos; Trapani, Tony; Tudora, Cristina Maria; Unterberg, Andreas; Vajkoczy, Peter; Valeinis, Egils; Vallance, Shirley; Vámos, Zoltán; van der Jagt, Mathieu; van der Naalt, Joukje; Van der Steen, Gregory; van Dijck, Jeroen T. J. M.; van Erp, Inge A.; van Essen, Thomas A.; Van Hecke, Wim; van Heugten, Caroline; Van Praag, Dominique; van Veen, Ernest; van Wijk, Roel; Vyvere, Thijs Vande; Vargiolu, Alessia; Vega, Emmanuel; Velt, Kimberley; Verheyden, Jan; Vespa, Paul M.; Vik, Anne; Vilcinis, Rimantas; Volovici, Victor; von Steinbüchel, Nicole; Voormolen, Daphne; Vulekovic, Peter; Whitehouse, Daniel; Wiegers, Eveline; Williams, Guy; Wolf, Stefan; Yang, Zhihui; Ylén, Peter; Younsi, Alexander; Zeiler, Frederick A.; Ziverte, Agate; Zoerle, Tommaso |
| Contributors: |
Nelson, L; Magnus, B; Yue, J; Balsis, S; Patrick, C; Temkin, N; Yuh, E; Diaz-Arrastia, R; Ryu, E; Maas, A; Menon, D; Wilson, L; Manley, G; Grandhi, R; Keene, C; Madden, C; Mccrea, M; Merchant, R; Mukherjee, P; Ngwenya, L; Puccio, A; Robertson, C; Schnyer, D; Taylor, S; Vassar, M; Ackerlund, C; Adams, H; Amrein, K; Andelic, N; Andreassen, L; Anke, A; Antoni, A; Audibert, G; Azouvi, P; Azzolini, M; Bartels, R; Barzó, P; Beauvais, R; Beer, R; Bellander, B; Belli, A; Benali, H; Berardino, M; Beretta, L; Blaabjerg, M; Bragge, P; Brazinova, A; Brinck, V; Brooker, J; Brorsson, C; Buki, A; Bullinger, M; Cabeleira, M; Caccioppola, A; Calappi, E; Calvi, M; Cameron, P; Lozano, G; Carbonara, M; Castaño-León, A; Cavallo, S; Chevallard, G; Chieregato, A; Citerio, G; Clusmann, H; Coburn, M; Coles, J; Cooper, J; Correia, M; Čović, A; Curry, N; Czeiter, E; Czosnyka, M; Dahyot-Fizelier, C; Dark, P; Dawes, H; De Keyser, V; Degos, V; Della Corte, F; Boogert, H; Depreitere, B; Đilvesi, Đ; Dixit, A; Donoghue, E; Dreier, J; Dulière, G; Ercole, A; Esser, P; Ezer, E; Fabricius, M; Feigin, V; Foks, K; Frisvold, S; Furmanov, A; Gagliardo, P; Galanaud, D; Gantner, D; Gao, G; George, P; Ghuysen, A |
| Publisher Information: |
Elsevier B.V.; NL |
| Publication Year: |
2025 |
| Collection: |
Università degli Studi di Milano-Bicocca: BOA (Bicocca Open Archive) |
| Subject Terms: |
Blood-based biomarker; Classification; Item response theory; Neuroimaging; Severity; Traumatic brain injury |
| Description: |
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). |
| Document Type: |
article in journal/newspaper |
| File Description: |
ELETTRONICO |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/41192220; info:eu-repo/semantics/altIdentifier/wos/WOS:001613070300001; volume:121; issue:November 2025; journal:EBIOMEDICINE; https://hdl.handle.net/10281/575363 |
| DOI: |
10.1016/j.ebiom.2025.106001 |
| Availability: |
https://hdl.handle.net/10281/575363; https://doi.org/10.1016/j.ebiom.2025.106001 |
| Rights: |
info:eu-repo/semantics/openAccess ; license:Creative Commons ; license uri:http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.50FC670B |
| Database: |
BASE |