Simple Blood Test Can Detect Injury and Mild Concussion

A simple blood has detected evidence of concussions in patients up to seven days after their injury, which could greatly expand the window for diagnosing concussions, especially in patients who experience a delayed onset of symptoms.

Almost all concussions in children are diagnosed only by symptoms, which are either observed, like vomiting or loss of balance, or symptoms reported by the child, like blurred vision or headache and neither scenario gives doctors and objective way to determine the severity of the injury.

Investigators at the Orlando Regional Medical Center (Orlando, FL, USA) enrolled adult trauma patients seen at a level I trauma center from March 1, 2010, to March 5, 2014 in a prospective cohort study. A total of 1,831 blood samples were drawn over seven days from 584 patients, mean age, 40 ±16 years; and 62.0% were male. Repeated blood sampling was conducted at 4, 8, 12, 16, 20, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144, 156, 168, and 180 hours after injury.

The biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C- terminal hydrolase L1 (UCH-L1) were measured. These proteins are found in glial cells, which surround neurons in the brain, and when an injury occurs, the GFAP are released. What makes them unique is that they pass the blood-brain barrier and enter the bloodstream, making them easy to detect with this particular test. Both GFAP and UCH-L1 were detectible within one hour of injury. GFAP peaked at 20 hours after injury and slowly declined over 72 hours. UCH-L1 rose rapidly and peaked at eight hours after injury and declined rapidly over 48 hours. Over the course of one week, GFAP demonstrated a diagnostic range of areas under the curve for detecting mild to moderate traumatic brain injury (MMTBI) of 0.73 to 0.94, and UCH-L1 demonstrated a diagnostic range of 0.30. For distinguishing patients with and without a neurosurgical intervention, the range for GFAP was 0.91 to 1.00 and the range for UCH-L1 was 0.50 to 0.92.

Linda Papa, MD, MSC, an emergency medicine physician, and lead author of the study, said, “This blood test could ultimately change the way we diagnose concussions, not only in children, but in anyone who sustains a head injury. We have so many diagnostic blood tests for different parts of the body, like the heart, liver and kidneys, but there has never been a reliable blood test to identify trauma in the brain. We think this test could change that.” The study was published on March 28, 2016, in the journal JAMA Neurology.

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