Study Evaluates Blood Test for Concussion Diagnosis in Trauma Patients

Understanding Concussions

A concussion is a form of brain injury that temporarily disrupts brain function. Typically caused by a direct blow to the head, concussions can also occur due to whiplash injuries, which jolt the brain within the skull. Common symptoms include headaches, dizziness, memory loss, confusion, nausea, vomiting, blurred vision, unusual behavior, drowsiness, or even loss of consciousness. Although emergency room personnel routinely check trauma patients for concussions, some may sustain brain injuries without displaying visible signs or symptoms, a condition known as “subconcussive” trauma. Identifying these patients is crucial, as they require careful monitoring to prevent potential brain damage from subsequent head injuries.

Significance of GFAP and UCH-L1 Proteins

Brain injuries trigger the release of specific proteins, namely GFAP and UCH-L1, into the bloodstream. A blood test designed to detect these proteins could assist medical staff in identifying patients with both concussive and subconcussive brain injuries. In a recent large-scale study conducted in the United States, researchers assessed the effectiveness of blood tests for GFAP and UCH-L1 in detecting these types of trauma. Their findings were published in BMJ Paediatrics Open.

Study Design and Methodology

The study involved over 700 adult and pediatric patients from three U.S. trauma centers, categorized into three distinct groups: individuals with head trauma and concussion, those with head trauma but without signs of concussion (non-concussive head trauma controls), and patients with body trauma but no head trauma or concussion (non-concussive body trauma controls). Blood samples were collected every four hours for the first 24 hours post-injury, followed by samples every 12 hours until 180 hours after the injury. In total, researchers analyzed over 1,900 blood samples to compare the levels of GFAP and UCH-L1 across the three groups.

Findings and Implications

Within four hours of injury, researchers observed incremental increases in GFAP and UCH-L1 across all three groups. The body trauma group showed the lowest elevations, while the non-concussive head trauma group exhibited mild elevations, and the concussive group recorded the highest levels. Notably, elevated levels of both proteins were detected in patients with non-concussive head trauma, which may indicate a subconcussive brain injury.

The study concluded that the GFAP blood test outperformed the UCH-L1 test in detecting concussions in both children and adults. The researchers indicated that the elevation of these proteins in non-concussive head trauma patients could suggest a subconcussive brain injury, warranting further investigation. The proposed blood test for concussions might offer advantages over traditional brain CT scans, as many patients with concussions or subconcussive trauma show no visible lesions in imaging studies.

Expert Insights and Future Directions

Dr. Linda Papa, the lead author of the study, emphasized the unique aspect of including patients who have sustained head injuries without symptoms, a demographic often overlooked in biomarker research. Ongoing efforts aim to develop a device that can be utilized in emergency rooms or at accident scenes to detect subconcussive brain injuries. Dr. Papa expressed optimism that such technology could be available within the next few years.

References

Papa L, Zonfrillo MR, Welch RD, et al. Evaluating glial and neuronal blood biomarkers GFAP and UCH-L1 as gradients of brain injury in concussive, subconcussive and non-concussive trauma: A prospective cohort study. BMJ Paediatr Open. 2019;3(1):e000473. Published 2019 Aug 25. doi:10.1136/bmjpo-2019-000473

Orlando Health. Press Release, Aug 26 2019. Study: Blood test detects concussion and subconcussive injuries in children and adults. https://www.eurekalert.org/pub_releases/2019-08/m-sbt082119.php