Heterogeneity of acute traumatic brain injured patients: how to identify phenotypes and tailor specific treatment

PURPOSE OF REVIEW: Traumatic brain injury (TBI) is a highly heterogeneous disease. Description of relevant phenotypes and endotypes could be essential for patient characterization, identification of pathobiological mechanisms, and development of tailored management. RECENT FINDINGS: A new approach to characterizing TBI patients has recently been proposed. It is based on a multidimensional framework (including clinical data, radiological findings, biomarkers, and modifiers) that could improve the scientific accuracy and the reproducibility of future phenotyping studies. TBI is a dynamic condition, and recent studies have shown that longitudinal data could provide additional insights into phenotypes and endotypes identification. Moreover, new studies have identified different phenotypes focusing on inflammation and coagulopathies which represent relevant mechanisms of secondary brain injury. Importantly, modern multiomics technologies have been used to explore TBI heterogeneity at the deepest level. SUMMARY: Strategies for identifying TBI phenotypes are rapidly evolving. They have the potential to provide an accurate characterization that could be helpful for tailored treatments. Further research is needed to translate phenotypes into clinical practice.