The collaborative study between Monash University researchers and The Alfred Emergency Department (ED) clinicians discovered that blood levels of three proteins, each reflecting different aspects of the biology of brain trauma, provided precision in classifying concussion for patients under the age of 50 who present to an ED within six hours of injury.
When the inflammatory biomarker, interleukin 6 or IL-6, was measured alongside glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1), two proteins exclusive to the brain, this combination showed incredible 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.
“Concussion diagnosis is notoriously challenging in many cases because clinicians rely on subjective observations of physical signs and self-reported symptoms, neither of which are specific to concussion and often exhibit subtlety and rapid evolution,” Dr McDonald said.
“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.”
“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.
“Given concussion remains a clinical diagnosis, the best clinical assessments and patient care are likely in the ED setting. Nevertheless, there is potential for this test to be applied beyond the hospital setting in the near future.”
“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,” Dr McDonald said.
The US Food and Drug Administration (FDA) has approved GFAP and UCH-L1 for use in predicting who has a bleed on CT scans, but the vast majority of concussion cases don’t involve brain bleeding.