What is the benefit of a biomarker in the assessment of head trauma in the emergency room?
Dr Beth McQuiston: Biomarkers offer an objective assessment that can help clinicians evaluate concussion in minutes. Compared with subjective measures – such as asking people how they feel, or if they are having difficulty with their memory – having a quick answer as to whether blood biomarkers highly correlated to brain injury are present in the blood can help with decision-making. The test is currently used in a hospital setting, but tomorrow, it could provide quick information to help make decisions on the sidelines, in the ambulance or on the playground.
The Alinity i TBI Plasma Test takes about 18 minutes and simultaneously measures proteins called GFAP and UCH-L1 in blood plasma. These two biomarkers have been shown to be elevated after brain injury. Normally, these brain proteins are typically found in extremely low levels in the blood. When elevated, they indicate that further evaluation is needed. People once said it would be impossible to help evaluate concussion with a blood test – but we’ve gone from impossible, to possible. And someday, we will be at “of course”, when this becomes the standard of care in hospitals.
What are the tools used today in the assessment of head injuries and what are their limitations?
Up until now, when someone goes to the emergency room for a suspected concussion, they are asked a series of questions and to do simple things like close a fist or follow a light with their eyes. Often, these types of assessments are followed up with a CT scan.
CT scans are useful to evaluate whether a skull fracture has occurred or if there is internal bleeding. That said, most mild traumatic brain injuries will be negative on a head CT, registering that no damage is visible even though brain injury has occurred.
How can a biomarker-based test improve on the current standard of care?
The Alinity i TBI Plasma Test gives us an objective, additional result. If the result is negative, it can eliminate the need for a CT scan, potentially saving money and eliminating lengthy wait times in the emergency room. That may mean less radiation exposure, increased cost savings, shorter length of stay, decreased resource utilisation and more peace of mind. We estimate this test has the potential to reduce the number of unnecessary CT scans for suspected TBI (traumatic brain injury) by up to 40%.
The test may also help increase community access to brain injury diagnosis and treatment. Not all head injury cases require a head CT scan, which can cost thousands of dollars, and not all people live in areas of the country where CT scans are close by. This test is a very accessible solution for patients and providers.
We designed our blood test for both lab use – which can run many samples at one time – and for a portable device because we want to make sure it is as accessible as possible. It’s important to have a blood test for concussion available for use on multiple platforms so the test can be available in different types of environments where people receive care.
How could the TBI test be integrated into clinical practices inside and outside the hospital?
In clinical practices, we hope that our test can work together with CT scans and other imaging tools to provide doctors with a complete and accurate understanding of a patient’s condition while enabling more rapid triaging of patients and offering increased efficiency for healthcare professionals.
Today, the test can be used in hospitals for adults aged 18 and older. Our hope for the future is that no concussion goes undiagnosed, and that patients will be able to get a quick answer in order to determine if they have suffered a brain injury so they can take appropriate next steps. After all, you can’t treat what you don’t know.
