January 06, 2020
A new blood test can accurately identify which elderly concussion patients do not have brain tissue damage and therefore do not need a computed tomography (CT) scan, speeding up the diagnosis and treatment process, a new study finds.
The blood test used in the study, published in the American Association for Clinical Chemistry's Journal of Applied Laboratory Medicine, is the first to evaluate mild traumatic brain injury or concussion in patients who may have intracranial bleeding.
Researchers found that the blood test was 100% accurate at identifying who did not have brain tissue damage, removing their need for a CT scan. However, it was not accurate at identifying patients who did have damage.
Because of this, the blood test can be effective as a rule-out test, but has limits as a rule-in test, researcher Robert H. Christenson, of the University of Maryland School of Medicine in Baltimore, emphasized in a statement. He and his colleagues recommend that hospitals use it as a part of the triage process for elderly concussion patients, but not as a replacement for CT scans.
Older adults are a particularly at-risk group for concussions for a couple of reasons. First, mental impairment related to intracranial bleeding can be hard to distinguish from age-related cognitive issues or dementia in elderly patients making the diagnosis process more challenging.
And second, older adults have a higher risk of falling. According to the Centers for Disease Control and Prevention, millions of seniors experience a fall each year, increasing their risk for concussion and even death. Fall-related mortality in the United States increased 30% in older adults from 2007 to 2016.
The test, approved by the U.S. Food and Drug Administration in 2018, measures two proteins – glial fibrillary acidic protein (GFAP) and ubiquitin carboxyle-terminal esterase L1 (UCH-L1).
To see whether the blood test could offer quicker diagnosis and treatment for elderly concussion patients, Christenson and his colleagues analyzed data from 1,959 concussion patients, age 65 years or older, who had both a CT scan and a blood test done to identify brain tissue damage. The tests were all performed within 12 hours of their injuries as a part of the Prospective Clinical Evaluation of Biomarkers of Traumatic Brain Injury (ALERT-TBI) study.