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Traumatic brain injury (TBI) continues to be a global burden. Due to its complex pathophysiology and limited knowledge of its severity, mortality, and morbidity remain relatively high. The Glasgow Coma Scale (GCS) has been used for almost fifty years to determine the severity of TBI, but its use has recently been questioned. Blood and cerebrospinal fluid biomarkers have been studied to determine the severity of TBI cases. The CSF-blood ratio of albumin levels could be one option to determine TBI severity, this ratio could determine BBB integrity. BBB disruption was one of the pathophysiology that could cause cerebral edema and altered blood flow that will worsen its outcome. Recent studies showed that BBB integrity play a pivotal role in TBI pathophysiology, influencing GCS score and patient outcome. Therefore, the CSF-blood albumin ratio could be used to determine the severity of TBI but further studies are needed to confirm this finding.
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