Corrigan John D, Alosco Michael L, van der Naalt Joukje, Adams Rachel Sayko, Asken Breton M, Hinds Sidney, Lequerica Anthony H, Newcombe Virginia, Tenovuo Olli, Valera Eve, Yurgelun-Todd Deborah, Doperalski Adele, Awwad Hibah O, Dams-O'Connor Kristen, Maas Andrew I R, McCrea Michael A, Umoh Nsini, Manley Geoffrey T
Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA.
Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
J Neurotrauma. 2025 Jul;42(13-14):1086-1095. doi: 10.1089/neu.2024.0590. Epub 2025 May 20.
The National Institute of Neurological Disorders and Stroke (NINDS) convened experts in traumatic brain injury (TBI) research, policy, clinical practice and people with lived experience to propose a system of injury classification less susceptible to misinterpretation and misrepresentation inherent in the current use of "mild", "moderate" and "severe". One of six working groups addressed Retrospective Classification of TBI. The Working Group consisted of 14 experts in brain injury research representing a breadth of professional disciplines. Initial conclusions based on expert opinion were vetted and revised based on public input at the January 2024 NINDS TBI Classification and Nomenclature Workshop. The Working Group examined five types of methodologies for identifying past TBIs (self/proxy-report, medical record extraction, imaging, fluid-based biomarkers, and performance-based tests). They concluded that self/proxy-report is essential for clinical, research and surveillance applications and that clinicians and researchers should employ elicitation protocols that have been studied and found valid. Medical record extraction was also identified as an invaluable tool for identification of past history of medically attended TBIs; however, there is a need to standardize the case definition employed and procedures used. The use of imaging methods, fluid-based biomarkers, and performance-based assessments in isolation lacked sufficient evidence of both sensitivity and specificity in detecting past histories of TBI to be recommended for this use at this time. The Working Group also evaluated identification of repetitive head impacts (RHI), finding no evidence of a common definition of RHI, a requisite initial step for the development and validation of standardized instruments.
美国国立神经疾病与中风研究所（NINDS）召集了创伤性脑损伤（TBI）研究、政策、临床实践领域的专家以及有实际经验的人士，以提出一种损伤分类系统，该系统不易受到当前使用的“轻度”“中度”和“重度”所固有的误解和错误表述的影响。六个工作组之一负责TBI的回顾性分类。该工作组由14名脑损伤研究专家组成，代表了广泛的专业学科。基于专家意见得出的初步结论在2024年1月的NINDS TBI分类和命名研讨会上根据公众意见进行了审核和修订。该工作组研究了五种识别既往TBI的方法（自我/代理人报告、病历提取、影像学、基于体液的生物标志物和基于表现的测试）。他们得出结论，自我/代理人报告对于临床、研究和监测应用至关重要，临床医生和研究人员应采用经过研究且被证明有效的引出方案。病历提取也被确定为识别有医疗记录的既往TBI病史的宝贵工具；然而，需要对所采用的病例定义和程序进行标准化。目前，单独使用影像学方法、基于体液的生物标志物和基于表现的评估在检测既往TBI病史方面缺乏足够的敏感性和特异性证据，因此不建议此时用于此用途。该工作组还评估了重复性头部撞击（RHI）的识别情况，发现没有证据表明存在RHI的通用定义，而这是开发和验证标准化工具的必要初始步骤。
