Can concussion be tested for with a ‘simple’ blood test?
Researchers at Orlando Health, a hospital in Florida, are making progress in finding ways to detect sub concussive injuries in children and adults. In a recent study of more than 700 emergency room patients, published in the journal BMJ Paediatrics Open, a blood test was used to test the levels of two proteins found in our brains and released into blood after an injury. These proteins are known to be associated with mild to moderate traumatic brain injury. The findings could indicate a step towards an earlier diagnosis and treatment of concussion and sub concussive injuries in patients.
What is a sub concussive injury?
Concussions are usually caused by some kind of trauma to the head, like falling over or being in a car accident. The trauma causes the brain to actually stop working normally for a period of time, sometimes permanently. Symptoms can include:
- Dizziness or balance problems
- Blurry vision
- Changes in mood – irritability, sadness, nervousness
- Sensitivity to light/noise
Sub concussive injuries are usually considered a milder form of head trauma with less obvious or sometimes no symptoms. Both concussions and sub concussive injuries are linked to negative long term effects on the brain.
Children are particularly at risk if they have suffered a concussion or sub concussive injury as they may not be able to tell you how they are feeling. Sometimes, the symptoms may not even appear until hours or even days after an injury, making it even harder to determine if they were hurt.
Historically, people who have suffered head trauma without obvious concussion symptoms have been classified as having ‘no injury’.
The study – Examining emergency room patients
Dr Papa, an emergency medicine doctor at Orlando Health, and her colleagues conducted a study to see if they could identify a sub concussive injury through a blood test. Dr Papa’s findings of the study was published in August 2019.
The study analysed participants, with and without head trauma, presenting at A&E with a normal mental status. This included patients who had full concussions as well as those who had experienced head trauma but showed no obvious symptoms. The patients studied included those who had experienced a variety of injuries including falls and bicycle accidents.
The pattern of protein levels was investigated in the blood samples at 20 distinct points in time, spanning seven days following the point of injury. This makes the study one of the first and largest investigations of trauma patients presenting with normal mental status.
Within four hours of their injury, incremental increases in levels of two types of protein (GFAP and UCH-L1) were found in the blood of patients. This indicates that the elevation in protein may represent milder forms of concussion and sub concussive injuries that do not elicit typical signs or symptoms associated with concussion.
How can this study help patients who have suffered a mild traumatic brain injury?
Given the lack of concussive and sub concussive symptoms, the presence of particular proteins that are known to be associated with head trauma could provide a more objective measure of injury and potentially identify those at risk for neurocognitive problems.
Currently, to detect a concussive or sub concussive brain injury, a doctor will carry out a physical examination involving a series of screening questions looking for cognitive and neurological symptoms. A CT scan might then be ordered to look for bleeding or swelling in the brain. An MRI scan, which is more sensitive, may then be performed. MRI scanning is not available in every hospital and can be slower to give results as the scan needs to be studied by a radiologist (a doctor trained in interpreting scans and x-rays) and possibly discussed with other specialists. This means that the results are unlikely to be available immediately.
The findings could lead to the development of a blood test to quickly identify potentially dangerous sub concussive injuries. Dr Papa’s study used a handheld blood analyser that produces test results in minutes. The blood test might be a cheaper and more convenient way to test for brain injuries and could be used in settings other than a hospital, such as schools, ambulances or road side at the scene of car accidents. The test could be used to determine which groups of people should be screened further for an MRI or further diagnostic tools to detect traumatic brain injury.
Further research is required however and I hope that the information gathered in this study leads to more effective treatment of people who have suffered a mild traumatic brain injury. The stage is set for future studies to verify these findings and develop the testing further.
Mollie Benjamin is a solicitor at Bolt Burdon Kemp in the Child Brain Injury team. If you feel you may have a claim or are enquiring on behalf of a loved one, contact Mollie free of charge and in confidence on 020 3973 4998 or at firstname.lastname@example.org. Alternatively, complete this form and one of the solicitors in the Child Brain Injury team will contact you. Find out more about the Child Brain injury team.