MedicalResearch.com Interview with:
Dr. Linda Papa
Linda Papa MD.CM, MSc, CCFP, FRCPC, FACEP
Director of Academic Clinical Research
Attending Emergency Physician
Orlando Regional Medical Center
Professor, University of Central Florida College of Medicine
Associate Professor, Florida State University College of Medicine
Adjunct Professor, University of Florida College of Medicine and Department of Neurology and Neurosurgery McGill University
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Papa: The temporal profile of these biomarkers has never been examined in mild TBI/concussion patients before. Research has focused on severe traumatic brain injury (TBI) but not enough work has been done in mild TBI/concussion. GFAP and UCH-L1 had very distinct temporal profiles in this study. It was a very pleasant surprise that GFAP performed so well and performed so consistently throughout the 7 days after injury. This suggests that GFAP could be used for clinical decision making over a week post-injury. The early peak in UCH-L1 was very exciting but its rapid decline will limit its use at later time points.
1- The biomarkers could be used to detect a mild traumatic brain injury/concussion in patients following trauma acutely (GFAP, UCH-L1) such as in the emergency department or urgent care clinic or perhaps in the prehospital setting. Notably, GFAP could also be used later (up to 7 days) in patients who may not seek immediate medical attention.
2- The biomarkers could help with determining the need for a CT scan of the brain acutely (GFAP, UCH-L1) or after several days (GFAP). This is particularly important in younger patients who are more sensitive to ionizing radiation. It also has implications for hospitals in rural settings who may not have access to CT scans 24 hours/day.
3- The biomarkers could help identify patients who may need neurosurgical intervention very early after injury so patients could be transported to facilities where neurosurgical care is always available.
Some specific scenarios in which these biomarkers would be particularly helpful include:
- In patients who are intoxicated with drugs or alcohol (because they are cognitively impaired).
- In patients with polytrauma who have multiple injuries (other injuries distract from potential brain injury).
- In elderly patients who cannot express their symptoms or in children who cannot express their symptoms (we examined children in a separate study published in Academic Emergency Medicine in Nov 2015).
- In athletes with head trauma during play.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Papa: These data focus on mild TBI/concussion patients. Getting blood samples from these patients over time is very challenging but is extremely important because individuals with mild TBI/concussion can present at different times after injury. Some patients do not seek medical attention for several hours to days after their injury. GFAP appears to be useful both early and late after injury. UCH-L1 is only helpful early on. This study captures the real-world setting in which traumatic brain injury biomarkers would be used by comparing a large number of trauma patients with TBI to a large number of trauma patients without a TBI. This study provides physicians with information about when and how these biomarkers could be used to evaluate trauma patients with suspected mild TBI/concussion.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Papa: These data provide valuable information on the diagnostic accuracy of GFAP and UCH-L1 at 20 distinct time points over 7 days after head trauma. They reflect severity of brain injury (higher levels indicate more severe injury). As with other blood tests, these biomarkers are tools to complement clinical judgment.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Papa: Physicians have access to many blood tests for different organ systems in the body such as troponin for cardiac ischemia, creatinine for kidney impairment, TSH for thyroid function, etc…. As of yet, there is no FDA approved blood test for traumatic brain injury . These results support GFAP as a robust marker for mild TBI/concussion. These blood tests are being commercialized for FDA approval.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Papa L, Brophy GM, Welch RD, et al. Time Course and Diagnostic Accuracy of Glial and Neuronal Blood Biomarkers GFAP and UCH-L1 in a Large Cohort of Trauma Patients With and Without Mild Traumatic Brain Injury.JAMA Neurol. Published online March 28, 2016. doi:10.1001/jamaneurol.2016.0039.
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Linda Papa MD (0). Blood Biomarkers Can Help Evaluate Mild Concussion MedicalResearch.com