Blood Test Could Assess Concussion Severity in Teenagers with TBI

Diagnosing and monitoring concussion in adolescents is challenging because symptoms can persist for weeks and vary widely between patients. The need for objective tools is especially urgent for teen girls, who often experience more severe and prolonged post-concussion symptoms. A new study has now identified blood-based biomarkers that correlate with symptom severity — with clear biological differences between male and female adolescents — offering a potential path toward more precise concussion care.

The research was conducted at Johns Hopkins University (Baltimore, Maryland, USA) using data from the ongoing CARE4Kids (Concussion Assessment, Research, and Education for Kids) study. The study involved a cohort of adolescents aged 11 to 18 years who continued to experience symptoms one to five weeks after a concussion. The approach focused on measuring five biomarkers — proteins and lipids released from the brain following injury — previously studied in adults with traumatic brain injury.

Using blood samples, researchers evaluated biomarker levels and examined how they related to the severity and type of ongoing symptoms. Importantly, they also analyzed differences between males and females, addressing a long-standing research gap, given that adolescent girls often report more intense symptoms and slower recovery. The findings revealed several sex-specific patterns. Female patients showed higher levels of tau, a protein associated with axonal injury, compared to males.

Across both sexes, elevated p-tau181 correlated with more severe cognitive symptoms. In girls, higher levels of N-FL and UCH-L1 — markers of neuronal damage — were linked to increased emotional symptoms. Conversely, among boys, lower levels of N-FL, UCH-L1, and p-tau181 were associated with worse physical and overall symptoms. These relationships persisted after adjusting for age, BMI, and time since injury.

These results indicate that sex moderates how biomarker levels reflect symptom burden in adolescent concussion. They also suggest potential interactions between hormone activity and brain-injury responses. The study, published in Journal of Head Trauma Rehabilitation, adds to growing evidence that concussion biomarkers may help clinicians track recovery, identify adolescents at risk for prolonged symptoms, and personalize treatment strategies, particularly for girls who remain underrepresented in concussion research.

“Our study builds on previous research suggesting that some brain-related markers may provide objective measures of brain injury in teens with concussion,” said lead author Mia Pasini, MSN, PMHNP-BC. “We also identify sex-specific differences in biomarker levels, which may lend insights into the more severe symptoms and longer recovery after concussion in girls and young women.”

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