Faculty Collaboration Database

Toward More Holistic Early Traumatic Brain Injury Evaluation and Care: Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Psychosocial and Environmental Modifiers Working Group. J Neurotrauma 2025 Jul;42(13-14):1023-1037

Date

06/04/2025

Pubmed ID

40464097

Pubmed Central ID

PMC12270537

DOI

10.1089/neu.2024.0569

Scopus ID

2-s2.0-105009630976 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

Biopsychosocial and environmental factors play a major role in acute clinical presentation, recovery, and outcome of traumatic brain injury (TBI). As part of the 2024 National Institute of Neurological Disorders and Stroke (NINDS) TBI Classification and Nomenclature Initiative, the Psychosocial and Environmental Modifiers (PEM) Working Group was assembled to perform a narrative review and summary of expert opinions regarding how non-TBI factors influence the presenting features and outcomes of TBI and to make recommendations for incorporating these Modifiers into clinical care and research. With input from working group members and other interested parties, we summarize the membership, methods, and outcomes of the PEM Working Group activities. Modifiers were considered with the NINDS Social Determinants of Health Framework in mind and fall under three broad headings: individual-level variables (e.g., demographics, preinjury health, culture), injury-related variables (e.g., cause and context of injury, second insults), and community-/societal-level factors (e.g., family/community support, socioeconomic position, structural racism). Recommendations include steps to increase awareness of Modifiers in health care encounters, identify Modifier-related disparities in TBI-related care and outcomes, better understand the mechanisms by which Modifiers influence TBI-related clinical presentation and outcomes, and intervene to improve the health and well-being of persons exposed to TBI. These recommendations are intended to be a starting point that will evolve as knowledge grows and additional input is incorporated.

Author List

Nelson LD, Wilson L, Albrecht JS, Arciniegas DB, Barthélemy EJ, Fontaine SN, Gardner RC, Juengst SB, Pappadis MR, Ponsford J, Thomas DG, Yeates KO, Dams-O'Connor K, Manley GT, Maas AIR, McCrea MA, Awwad HO, Doperalski A, Umoh N

Authors

Michael McCrea PhD Professor in the Neurosurgery department at Medical College of Wisconsin
Lindsay D. Nelson PhD Professor in the Neurosurgery department at Medical College of Wisconsin
Danny G. Thomas MD, MPH Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Brain Injuries, Traumatic
Humans
National Institute of Neurological Disorders and Stroke (U.S.)
Social Determinants of Health
Terminology as Topic
United States