To develop a robust, evidence-based model addressing the need for an updated and broadly applicable classification system for TBI to optimize the care landscape.

The initiative was primarily based on a process of multidisciplinary expert consensus across March 2022 to January 2025, informed by a literature review, and participation of many international experts, working under the premise that any novel approach to characterization should be applicable worldwide.

The CBI-M framework is intended for use in patients with TBI of all severities (GCS score 3–15). Importantly, while all pillars offer important and valuable information, the NIH-NINDS group highlights both the nuances and the importance of the sequence of assessment. The clinical pillar should be assessed as the first priority, and for patients who present with a clinical indication for urgent imaging, the neuroimaging pillar should be prioritized over the biomarker pillar. In cases without, or with uncertain indication for imaging, the biomarker pillar has a greater relevance for providing evidence of brain injury, and to inform the need for CT scanning. The modifier pillar offers components that may be assessed acutely, while some may be more relevant to the chronic phase to assess recovery.

The CBI-M framework emerges as a pivotal response to decades of challenges in TBI classification, addressing critical gaps identified over 50 years of TBI research. This paradigm shift aligns with evolving clinical needs for TBI diagnostics, emphasizing empirical decision support over traditional severity labels.

The framework’s multidimensional design allows incremental implementation while maintaining compatibility with existing clinical infrastructure. While the proposed CBI-M framework is not a finished product, it offers a promising, multidimensional instrument for the improved characterisation of TBI in response to calls from the community and recommendations of the 2022 NASEM report.