A new study published in JAMA Network Open compares the performance of a blood test for traumatic brain injury (TBI) to three clinical decision rules used by emergency medicine physicians. JAMA Network Open is an international, peer-reviewed, open access, general medical journal.
A new study by researchers at Orlando Health Orlando Regional Medical Center (ORMC) found a blood test for traumatic brain injury performs just as well as the clinical guidelines emergency medicine physicians use to decide if a patient with a mild traumatic brain injury or concussion needs a computed tomography (CT) scan. The discovery of the high performance TBI biomarkers blood test may improve the detection of brain injuries on CT, while reducing the need for CT scans. The study was recently published in JAMA Network Open, an international, peer-reviewed, open access, general medical journal.
Currently physicians rely on CT imaging to initially evaluate mild traumatic brain injury or concussion.
“Roughly ten percent of patients with so-called mild TBI or concussions can have serious brain injuries on CT scan that require rapid treatment. It is critical to detect these injuries,” said Linda Papa, MD, lead author of the study and emergency medicine physician and director, Academic Clinical Research, ORMC. “This also means that the majority of patients will not need a CT scan. Minimizing exposure to unnecessary radiation from CT scans is also a consideration.”
During the study, participants had a CT scan ordered by emergency physicians based on current clinical guidelines — the Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), and the National X-Radiography Utilization Study II (NEXUS II). The same participants also received the blood test that detects the two FDA-approved biomarkers (GFAP and UCH-L-1) that are present after brain injury. The results of the blood test were compared to these three validated clinical decision rules.
Findings indicate the blood test, the CCHR, and the NOC were each 100 percent sensitive in detecting CT lesions on their own. The sensitivity for NEXUS II was only 83 percent. The study also found the combined use of the test and clinical guidelines improved the accuracy even more. Specifically, the combination of the GFAP biomarker with the CCHR had the highest diagnostic performance of all combinations.
“There is a balance between correctly identify patients with brain injuries on CT scan (the sensitivity) and correctly identifying patients without injuries on CT (the specificity). The best balance came from combining GFAP with the CCHR clinical guideline,” said Dr. Papa.
The study also asked physicians, while they were caring for these patients, if they thought testing for biomarkers would be helpful.
“We found that 86 percent of emergency medicine physicians like the idea of having a blood test for patients with mild traumatic brain injury or concussion,” said Dr. Papa. “There was considerable enthusiasm about an objective measure of brain injury. While the biomarkers are FDA approved for mild TBI, the question for clinicians always remains – Is it better than what we currently do?”
A blood test to detect mild traumatic brain injury has been a significant milestone in traumatic brain injury research – critical to diagnosis and treatment for patients.
“Physicians use blood tests in combination with clinical decision making for many conditions like coronary heart disease, kidney disease and diabetes,” said Dr. Papa. “The prospect of having a blood test that could enhance our clinical decision making in patients with mild TBI and concussion is remarkable. This could potentially change the way we treat these patients going forward.”
Researchers at ORMC were leaders in identifying the two biomarkers used in the blood test to detect brain injury and have continued to evaluate different aspects of the blood test through various studies. Previous studies have been published in various publications including Journal of Neurotrama, JAMA Neurology, BMJ Paediatrics Open, Academic Emergency Medicine, and Journal of Trauma.
