Traumatic brain injury (TBI) is a leading cause of disability in the United States. Mild TBI is known as concussion, defined as an injury resulting from a bump or blow to the head that is not necessarily accompanied by a physical deficit that can be seen during examination or brain imaging. Because the symptoms of concussion are notoriously subtle—patients often describe feeling “dazed and confused” or “seeing stars”—it is the most difficult form of TBI to diagnose. Clinicians currently rely on subjective, self-report diagnostic strategies to identify concussion in patients. However, many patients report feeling fine immediately after an injury, even though they may experience long-term deficits in memory, cognition, mood, sleep quality, and other important life domains. As a result, researchers are motivated to find a more objective way to diagnose concussion.
A company called BRAINBox Solutions, in collaboration with researchers at Virginia Tech, is making great strides towards this goal. They are working to develop a portable system that measures blood biomarkers—measurable substances in the body that can indicate the presence of specific diseases—to help doctors diagnose a concussion. The concussion tool will identify two proteins, known as UCH-L1 and GFAP, that increase in the blood up to 12 hours following a TBI. If a patient’s blood shows high levels of UCH-L1 and GFAP after an injury, it’s likely that the patient has suffered a concussion.
To assist the production of this tool and its delivery to the market, the Food and Drug Administration recently granted the test the designation as a “Breakthrough Device,” which will expedite its FDA review process once the creators feel that it is ready for use. This designation speaks to the severity of concussion as a public health crisis, the necessity of such a tool to improve patient outcomes, and the confidence in these researchers to successfully develop and implement this measure.
According to the researchers, this tool would ideally be used in conjunction with the current assessments of patient behavior and cognition to provide a definite diagnosis, which can subsequently inform treatment options. For example, physical and cognitive rest are effective treatments that allow the injured brain to conserve resources and allocate energy towards damage repair. Reliable TBI diagnosis, especially in the absence of outward symptoms, may encourage employers to grant time off for employees who “seem fine” after sustaining a head injury. And student athletes who sustain injuries may be more likely to take an important rest period if formally diagnosed with TBI, facilitating their recovery and eventual return to gameplay.
Although a concussion may not cause severe, recognizable symptoms, it is a serious injury that can cause long-term impairments and may significantly reduce quality of life. Fortunately, blood biomarker tools can improve diagnosis, care, and outcomes for the nearly 3 million people who visit the emergency department for head injuries each year.