On May 21,The Lancet Neurology (impact factor 46.6), a leading international medical journal, published a commentary article titled "Integrating the characterisation of traumatic brain injury," co-authored by Professor Jiang Ji'yao, Director of the Shanghai Institute of Head Trauma and Chief Expert, and Professor Feng Junfeng, Director of the Department of Neurosurgery at Renji Hospital. The article provides an objective commentary on a newly proposed "Traumatic Brain Injury Classification and Nomenclature Initiative" released by the U.S. National Institute of Neurological Disorders and Stroke (NINDS), a branch of the National Institutes of Health (NIH), and offers a comprehensive and in-depth discussion from a global perspective on the diagnosis and treatment of traumatic brain injury (TBI).
TBI remains a serious public health issue worldwide. In China alone, hundreds of thousands of new TBI cases occur each year, imposing a heavy financial burden on patients and families and causing substantial social loss. For over 50 years, the Glasgow Coma Scale (GCS) has served as the primary tool for classifying TBI severity in neurosurgery. While GCS is widely used for its simplicity, scientific basis, and clinical utility, its limitations have become increasingly apparent with the rapid advancement of imaging technologies like CT and the continuous progress of neuroscience. Although many neurosurgeons globally have proposed alternative classification methods, a universally accepted system has yet to emerge.
To address this challenge, NINDS organized an international academic workshop last year, bringing together 94 experts from 14 countries. The workshop resulted in the development of a new framework for describing acute TBI, known as the CDE-based Injury Model (CBI-M). This innovative framework encompasses four key domains: clinical features (complete GCS and pupillary reactivity), biomarkers (blood-based), imaging (neuropathological features), and modifying factors (those influencing clinical presentation and prognosis). The goal is to provide a more comprehensive, objective, and scientifically accurate classification system. The findings were published inThe Lancet Neurology on the same day, aiming to offer a new reference model that could facilitate the refinement and global adoption of a unified TBI classification system.
Previously, Professor Jiang Ji'yao was invited by Editor-in-Chief Dr. Elena ofThe Lancet Neurology to author a professional commentary on the newly proposed CBI-M framework. Professor Jiang accepted the invitation and collaborated closely with Professor Feng Junfeng to write the article. In their commentary, they emphasize that the core of any TBI classification system lies in its ability to accurately reflect injury severity, which is crucial for effective treatment and outcome prediction. While the CBI-M framework makes an innovative attempt to provide a multidimensional characterization of TBI, the authors point out several limitations: the complexity of the framework may hinder clinical application; some indicators lack sufficient evidence or specificity; and the practicality of certain elements in developing countries remains questionable. They conclude that continued refinement and validation in real-world settings will be essential for the CBI-M framework to meet the global needs in TBI diagnosis and treatment.
This commentary was published concurrently with theNINDS proposal in The Lancet Neurology, with Jiang Ji'yao as the corresponding author and Feng Junfeng as the first author.
Under the leadership of Professor Jiang Ji’yao and Department Director Feng Junfeng, the Department of Neurosurgery at Renji Hospital has achieved significant advances in the field of TBI treatment. Since 2019, Professor Jiang has published seven high-quality academic articles inThe Lancet Neurology as an independent corresponding author. These accomplishments not only demonstrate the high standards of TBI treatment in China on the international stage but have also significantly enhanced the academic reputation and global visibility of Renji Hospital, making important contributions to the advancement of neurosurgery in China.
