Diagnosing concussions, a mild form of Traumatic Brain Injury (TBI) that affects thousands each year, can be difficult. Most diagnostic tools involve subjective, self-reported measurements. In addition, neuroimaging tests on concussed individuals typically come back as normal. The National Collegiate Athletic Association (NCAA) and US Department of Defense Concussion Assessment, Research, and Education (CARE) Consortium performed a study on 264 college athletes from 2015-2018 to help identify the potential of a new diagnostic tool: biomarkers.

“The goal of a biomarker is to provide a reproducible and accurate indicator of a medical state,” says Juliana VanderPluym, a neurologist at the Mayo Clinic not involved in the study.

Biomarkers have numerous diagnostic applications. For example, lipid biomarkers (e.g. HDL and LDL) are frequently used to assess one’s risk of heart disease. However, concussion biomarkers are in early stages of research. The present multi-center study examined several candidate biomarkers measured via blood samples from concussed athletes and non-injured controls.

Brain Scan

Image by moujemouje is licensed under CC BY-ND 2.0

Concussion severity was associated with higher levels of the following biomarkers: glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), and tau. While the biomarkers are not yet diagnostic by themselves, more research could help physicians decide on difficult or unclear concussion cases.

 

 

Juliana VanderPluym notes that “it is important to consider [biomarkers] as an aid, and not necessarily as the final determinant” of a diagnosis.

The study also compared biomarker levels in concussion patients with and without loss of consciousness (LOC) and posttraumatic amnesia (PTA). Concussions featuring LOC and PTA typically increase severity classification. In this comparison, GFAP levels were higher in concussed athletes with LOC or PTA than those with neither LOC nor PTA.

The research suggests a potential role of biomarkers in concussion diagnoses. Blood tests could help increase the certainty of the currently subjective diagnostic procedures. Further, biomarkers might also help gauge injury severity when other data—such as neuroimaging—come back normal.

 

Citation

McCrea M, Broglio SP, McAllister TW, et al. 2020. Association of blood biomarkers with acute sport-related concussion in collegiate athletes: findings from the NCAA and Department of Defense CARE Consortium. JAMA Network Open: 1-16