Blood test could improve concussion diagnosis

Thursday, 05 October, 2023

Blood test could improve concussion diagnosis

A Monash University-led study has discovered that a blood test identifying specific proteins or biomarkers could assist to diagnose concussion quickly and accurately, improving the diagnostic process of concussion following accidents, sport-related collisions or other injuries.

Published in Neurology, the study looked at four protein biomarkers: interleukin 6 (IL-6), glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1) and neurofilament light (NfL).

The collaborative study between Monash researchers and The Alfred Emergency Department (ED) clinicians discovered that blood levels of IL-6, GFAP and UCH_L1 provided precision in classifying concussion for patients under the age of 60 who present to an ED within six hours of injury. When the inflammatory biomarker, IL-6, was measured alongside GFAP and UCH-L1, the combination showed sensitivity and specificity in distinguishing individuals with concussion from those without.

Study lead and Monash Trauma Group Principal Investigator Dr Stuart McDonald said accurate diagnosis of concussion was often difficult as clinicians rely on symptoms, often self-reported, or tools like imaging that lacked sensitivity to this form of brain injury.

“Consequently, even in the ED, individuals can be discharged without a definitive diagnosis. Our findings showed that the panel of biomarkers we assessed performed really well even in patients that lacked the more overt signs of concussion, such as loss of consciousness or post-traumatic amnesia.”

In the same patients studied a week after their concussion, the researchers found another brain specific biomarker, NfL, was elevated in blood and had comparable diagnostic properties as the acute markers.

McDonald said this suggested NfL could be particularly suited to assisting concussion diagnosis in cases of delayed assessments.

“Beyond the ED, measures of blood NfL may be most beneficial when individuals consult a GP multiple days after an impact, especially in situations where diagnostic certainty is crucial for making safe return-to-work or return-to-play decisions, such as in military or sports settings,” McDonald said.

The test has potential to help manage sports concussion, according to McDonald.

“While at this stage it may not be feasible to conduct a test that alters decisions within a match, players with a potential or suspected concussion that are removed from play could feasibly be tested soon after the match, with a more definitive diagnosis helping with many aspects of the player’s recovery and return-to-play process,” he said.

Biswadev Mitra, a co-study lead and Professor, Monash University, who is also the Director of Emergency Medicine Research at The Alfred, said if further research validated results and biomarkers were granted regulatory approval in Australia, they could increase diagnosis for both clinicians and patients, enabling earlier management.

Once approved, the blood test would be used alongside, rather than replace, existing diagnostic measures such as physical signs and symptom self-reporting, to improve accuracy.

Image credit: Borodai

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