A blood test for concussions is nearing reality, providing first responders with a critical tool for diagnosing and treating one of the major causes of death and disability in the United States.
In its final stages of development, the test measures the levels of two blood proteins to determine if someone has suffered a mild or moderate traumatic brain injury (TBI). It's a breakthrough that could have immediate ramifications on the battlefield and the playing field and in everyday life.
And it's coming. Soon.
"Before 2020, for sure," says Linda Papa, the lead author of a paper in the current issue of JAMA Neurology that details the test. "It's going through all the channels at the FDA, and once that gets approved — the device is already being built — it's a couple years away ... [But] the evidence is becoming very clear that this is going to be very useful."
The Neurology paper outlines a study that covers nearly 600 trauma patients between 2010 and 2014. Researchers drew blood from those screened for mild- to moderate-level brain injuries, starting from within four hours of injury to more than seven days after.
The scientists pinpointed two widely studied biomarkers — glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) — and found that they effectively determined the presence of a brain injury. These proteins aren't normally found in the blood, Papa says, and researchers are finding that the severity of the injury correlates with the level of the biomarker.
A test that tracks both biomarkers, researchers found, is useful just hours after an injury occurs and up to a week or so after.
According to the Centers for Disease Control and Prevention, TBIs account for about 30 percent of all injury deaths in the U.S. every year. In 2010, about 2.5 million emergency department visits, hospitalizations or deaths were associated with TBIs.
Much of the recent talk about concussions and TBIs has centered on sports, specifically football. But TBI is an everyday problem affecting the elderly, children and people in car accidents, among others.
Treating all those brain injuries has been complicated by the fact that many are not discovered through subjective screenings or scans. Yet the injury exists, and it can still have damaging, long-term effects.
"This has been something that has frustrated me for the longest time and has been really tough for patients; when somebody has an injury but is told they don't have an injury," says Papa, an emergency room doctor at the Orlando Regional Medical Center in Florida. "Standard tests will tell you that they're fine ... [T]hey say, 'Look I can't work like I did before, I don't feel like I did before.' But everybody's telling them, 'Well, your CAT scan's negative, your MRI's negative. You're fine.'"
For those patients, especially, this blood test is indispensable.
"If we can somehow say, 'Look, we found a high level of this marker in your blood. We know that your scan is normal, but we think you have an injury,'" Papa says. "'Let's get you into the system, let's get you to see a nurse-psychologist, a neurologist, let's start doing some cognitive therapy. Let's see if we can make you better.'
"We're hoping this blood test can give us that objective information that we can use to direct patients to care, so they don't spiral down this abyss and find themselves lost because nobody told them that they have a problem."