According to the National Institute of Neurological Disorders and Stroke, traumatic brain injury (TBI) can be because of a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain.1 TBI can have several primary effects on the brain, including different types of bleeding and tearing forces that injure nerve fibers and cause inflammation, metabolic changes, and brain swelling. Many factors of the brain injury such as the size, severity, and location of the influence, may determine how a TBI is treated and influence the time of recovery for a patient.
In March 2023, the FDA cleared Abbott’s Alinity i laboratory TBI blood test, the first commercially available test of its kind, which objectively evaluates concussions with a brain-specific biomarker in as little as 15 minutes.2 These blood tests aim to help clinicians evaluate patients with mild TBI by ruling out the need for a CT scan, allowing them to quickly determine the next steps for care. Despite the potential of this new available technology, the adaptation of these blood tests into clinical practice has been slow, according to the company.
In a recent conversation with NeurologyLive®, Beth McQuiston, MD, RD, neurologist and medical director at Abbott, gave her personal and clinical perspective on the latest trends among patients with TBI. In addition, McQuiston also discussed some of the specifics of what she is looking forward to this year in the field of concussion research and diagnosis. Furthermore, she spoke on the reasons for an increased focus on studying the use of blood markers in pediatrics and women's sports in the context of TBI.
Top Clinical Takeaways
- Blood tests for traumatic brain injury are gaining widespread endorsement, with national and international bodies incorporating them into clinical guidelines.
- The transformative potential of blood markers extends worldwide, with ongoing research in Australia, New Zealand, and collaborative efforts in pediatric and women's sports studies.
- Beyond diagnostics, a concerted campaign emphasizes the importance of recognizing concussion signs and symptoms, urging proactive measures for brain health.
NeurologyLive: What has recently happened in the field of concussion that you think is important for clinicians to be aware of?
Beth McQuiston, MD, RD: As a neurologist,it's exciting, as a lot has happened. Since we've been cleared, theNational Academy of Sciencehas put out a consensus statement saying that these blood tests should be adopted into clinical practice. The American Congress of Rehabilitation Medicine draft guidelines came out, which now include these blood tests in the very definition of traumatic brain injury themselves. So that's huge! At the National Institute for Health (NIH), there's going to be a consensus group going through the Glasgow Coma Scale definition, which is mild, moderate, and severe for traumatic brain injury, The group will be looking at ways to incorporate these blood tests into very definition of traumatic brain injury. It's going to be a big, important conference for neurology and concussion, where there will be global thought leaders at NIH in a huge event, and it’s going to help many patients. So, there is lots going on!
What trends have you observed in your own practice and research in patients with TBI?
I lead global neuroscience research, and we have studies all around the world. There's been such interest in and joy, frankly, that these markers are available because they're truly game changing. I was just out in Australia and New Zealand, they're looking at these markers too and putting together some papers looking at research in children, treatment, and prevention. Now that we have an objective, rapid way to assess injury, it just opens so many doors to help so many patients.
Is there anything else you're looking forward to this year in concussion?
There are a lot of publications that are coming out highlighting the use of these markers in large-scale trials, which is extremely important to show that this is reproducible and works in a variety of patients. There's going to be a paper that's being submitted about using these in pediatrics, which is another area we are looking into. We're also looking at this in women and sports with a lot of collaborations as women have a higher rate of concussion in every contact sport than men. This is huge since it is not just a male sports situation. Most concussions happen to older adults because of slips and falls. Then when you look at the athletic space, women and girls have a much higher rate of concussion than their male counterparts.
We're excited about looking at that to help patients come up with ways to prevent the condition because the best injury is no injury. In other words, the best problem is no problem. In essence, what we're doing with these blood tests is we're taking this invisible injury and making it visible, to see it and address it. The other thing that's been huge has been a Concussion Awareness Now campaign (concussionawarenessnow.org). It's a group of organizations that support brain health that all came together to say, “We need to address this, and these are the signs and symptoms of concussion. You don't just walk it off, you need to address it.” All of that is going to be important too.
Transcript edited for clarity.
1. National Insitute of Neurological Disorders and Stroke. Traumatic Brain Injury (TBI). Accessed January 9 ,2024. https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi
2. Abbott Receives FDA Clearance for First Commercially Available Lab-Based Blood Test to Help Evaluate Concussion. News Release. Abbott. Published March 7, 2023. Accessed January 9, 2024. https://abbott.mediaroom.com/2023-03-07-Abbott-Receives-FDA-Clearance-for-First-Commercially-Available-Lab-based-Blood-Test-to-Help-Evaluate-Concussion