{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:48:37Z","timestamp":1792648117311,"version":"4.5.0"},"reference-count":47,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T00:00:00Z","timestamp":1609718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Traumatic brain injury (TBI) has been described to be man\u2019s most complex disease, in man\u2019s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current classifications are primarily based on clinical evaluations, which are non-specific and poorly predictive of long-term disability. Brain imaging results have also been used, yet there are multiple ways of doing brain imaging, at different timepoints in this very dynamic injury. Severity itself is a vague concept. All prediction models based on combining variables that can be assessed during the acute phase have reached only modest predictive values for later outcome. Yet, these early labels of severity often determine how the patient is treated by the healthcare system at large. This opinion paper examines the problems and provides caveats regarding the use of current severity labels and the many practical and scientific issues that arise from doing so. The objective of this paper is to show the causes and consequences of current practice and propose a new approach based on risk classification. A new approach based on multimodal quantifiable data (including imaging and biomarkers) and risk-labels would be of benefit both for the patients and for TBI clinical research and should be a priority for international efforts in the field.<\/jats:p>","DOI":"10.3390\/jcm10010148","type":"journal-article","created":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T21:58:36Z","timestamp":1609797516000},"page":"148","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":141,"title":["Assessing the Severity of Traumatic Brain Injury\u2014Time for a Change?"],"prefix":"10.3390","volume":"10","author":[{"given":"Olli","family":"Tenovuo","sequence":"first","affiliation":[{"name":"Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, 20521 Turku, Finland"},{"name":"Department of Neurology, Institute of Clinical Medicine, University of Turku, 20500 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon","family":"Diaz-Arrastia","sequence":"additional","affiliation":[{"name":"3\tPerelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA\uff1b <email>ramon.diaz-arrastia@usuhs.edu<\/email>"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee E.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Alzheimer's Disease Research Center, College of Engineering, Boston University School of Medicine, Boston, MA 02118, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Sharp","sequence":"additional","affiliation":[{"name":"Clinical, cognitive and computational neuroimaging laboratory (C3NL), Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK"},{"name":"UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, W12 0NN UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joukje","family":"van der Naalt","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan D.","family":"Zasler","sequence":"additional","affiliation":[{"name":"Concussion Care Centre of Virginia and Tree of Life, Richmond, VA 23233, USA"},{"name":"Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1089\/neu.2008.0586","article-title":"Classification of traumatic brain injury for targeted therapies","volume":"25","author":"Saatman","year":"2008","journal-title":"J. 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