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      24 January 2025

      A traumatic brain injury (TBI) is a brain injury caused by an outside force, such as a forceful blow or an object entering the brain.1 TBIs must be diagnosed early and accurately, so treatment can start as soon as possible.2

      Rapid diagnosis = Timely treatment = Improved patient outcomes

      Traumatic brain injuries in sports: Spotlight on American football

      TBIs can lead to severe consequences, such as cognitive impairments and neurological disorders like chronic traumatic encephalopathy (CTE).1 Athletes who play contact sports like American football run a high risk of TBI sports injuries3 - one study by the Journal of the American Medical Association diagnosed CTE in 87% of former football players.3 Symptoms of CTE include cognitive difficulties such as problems with thinking and communication, issues with impulse control, depression, and movement disorders.1

      Clinicopathological evaluation of CTE in players of American football

      A repair protein called 18 kDa translocator protein (TSPO) is present in the brain at high levels immediately after a brain injury, as part of the inflammatory response and to facilitate repair. However, a study by Johns Hopkins Medicine on brain scans  of former National Football League (NFL) athletes found that high levels of TSPO persist long after head trauma such as a concussion have occurred. These findings suggest that brain injury and repair processes continue for years after players end their careers leading to long-term cognitive problems.4

      Brain scans of former NFL athletes show a repair protein in place long after initial injury

       

      Traditional methods of detecting concussion (mild TBI), and their limitations

      Concussion is a type of mild traumatic brain injury (mTBI) that is often considered temporary. It can be caused by a blow to the head, a sports injury or fall or a car accident. The healing process can vary widely, taking anywhere from a few minutes to several months.1 

      Did you know? Mild traumatic brain injury accounts for about 90% of all TBI cases.5

      All TBIs, including concussion, should be immediately evaluated by a medical professional with experience in head injuries:1 

      • A neurological exam can be used to assess motor and sensory skills, hearing and speech, coordination and balance, and changes in mood or behavior.
      • Brain imaging can be used to evaluate the extent of the brain injuries and determine if surgery will be needed.1 
      • Commonly used imaging methods for TBI include computed tomography (CT) and magnetic resonance imaging (MRI) scans. CT imaging can detect skull fractures, brain bruising, bleeding or swelling. MRI can pick up more subtle brain changes that a CT scan might not detect.1

      Recent advances in imaging, such as diffusion tensor imaging and susceptibility-weighted imaging, have made it easier to detect milder TBIs. However, despite these developments, imaging technologies can’t always diagnose mild concussive injuries.1

      The limitations of imaging tests6

      • Brain imaging is costly as it requires large, expensive machinery. 
      • Brain imaging provides only a ‘snapshot’ of the brain at a particular moment; it can’t capture the dynamic changes that occur in the brain over time.

      “If you are brought to an emergency room with a traumatic brain injury and your CT scan is negative, you are almost always told ‘you’re fine, go home’. But we now understand that a significant percentage of those patients are not fine, and in fact continue to have issues for months.”

                                                                                                             - Okonkwo D, 2024, University of Pittsburgh Medical Center, Pennsylvania7

      This is why medical professionals and sports organizations are now turning to blood biomarkers to obtain more comprehensive results. 

       

      Recent advancements in IVD testing for TBI detection

      In vitro diagnostic (IVD) tests provide a faster and often more accurate alternative to brain imaging. These minimally invasive tests require only a simple blood sample. IVD tests enable early and accurate TBI detection, leading to more effective treatment plans and better long-term outcomes for patients.8

      Specific IVD tests for TBI are becoming increasingly available. For example, GFAP and UCH-L1 biomarkers are well-validated and specific to brain injury. Elevated levels of these proteins in the blood are associated with brain injuries detectable through neuroimaging, aiding clinicians in deciding whether to order a CT scan.8

      Medix Biochemica specializes in providing high-quality, high-performing antibodies against many important neurology related markers, including  GFAP and UCH-L1. We look forward to continuing to support customers with similar raw materials as these tests and new assays become more readily available.8

      Explore our Neurology Offering

      Saliva testing also shows promise in mTBI detection. Diagnosing concussions by detecting salivary microRNAs offers a faster and even less invasive alternative to blood tests, and can easily be used in settings like on sports fields or in emergency situations.9

      Read more about the potential benefits of saliva testing

       

      The implications of these advancements for sports are significant

      With improved testing options for traumatic brain injuries available, the world of sports will benefit in several key ways:8

      • Player health and safety: More accurate and timely diagnostics will lead to better outcomes and inform better design of protective equipment. 
      • Quicker return-to-play decisions: Data-driven assessment of risk can improve understanding of when it is safe to return to play. 
      • Better rehabilitation protocols: Facilitating faster recovery.
      • Overall improved safety protocols: Development of standardized protocols across all levels of play, while informing ongoing research and education.

      The challenges of testing blood biomarkers8,10,11

      • Biomarkers are often present at low concentrations in the blood.
      • It is difficult to determine whether biomarkers in the blood reflect brain tissue damage or blood-brain barrier integrity. 
      • Biomarker levels can fluctuate rapidly after a brain injury. 
      • Other factors, such as the patient’s age, gender and pre-existing medical conditions, can influence biomarker levels.
      • Current detection methods may lack the sensitivity required. 
      • Biomarkers can be diluted in the bloodstream and degraded by the body’s natural processes, further reducing their detectable levels.

      To overcome these challenges, continued research and development are essential. Advancements in detection technologies and the identification of more robust biomarkers will enhance the accuracy and reliability of blood tests for traumatic brain injuries. Collaboration between researchers, medical professionals and technology developers is crucial to drive these innovations forward and improve patient outcomes.8b

      “Despite the aforementioned challenges, there is no question that the forthcoming years and decades will see a revolution in the diagnostics of brain disorders. Biomarkers have potential uses that other methodologies cannot replace. They may give information on injuries in different cell types and separate cellular compartments, such as axonal or synaptic injury. They may be used to monitor treatment responses rapidly. They can give – when used in validated panels – a comprehensive picture about the brain state non-invasively. Not least, they may be used for point-of-care rapid diagnostics, thus opening entirely new possibilities for the clinicians.”

                                                                                                                                              -Tenovuo O, 2021, University of Turku, Turku, Finland10

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      Future outlook for TBI detection

      Novel ideas currently being explored for the diagnosis of TBIs include:

      • The development of portable electroencephalogram (EEG) devices, using machine-learning algorithms to interpret EEG and imaging data, allowing for easier testing across a variety of settings (including sports fields).8
      • Equipping players with smart helmets and other wearables with impact sensors to help detect concussions in real time.12
      • Safer playing surfaces with better shock-absorbing capacity.13
      • The Head Health Initiative, a collaboration between General Electric (GE) and the NFL to accelerate diagnosis and improve treatment for traumatic brain injuries.14
      • Investigation of novel biomarkers offering new avenues for early and accurate TBI diagnosis.8b

      Read more about the Head Health Initiative

      Research into cutting-edge diagnostic technology for improved TBI diagnosis is ongoing.5

      TBI Detection: Past, Present and Future

      Contact Medix Biochemica to discuss our IVD testing raw materials for the detection of traumatic brain injuries and numerous other neurological conditions.

      Get in Touch!

       

      References:

      1. Traumatic brain injury (TBI). National Institute of Neurological Disorders and Stroke. Accessed December 10, 2024. https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi.
      2. Traumatic brain injury - diagnosis & treatment. Mayo Clinic. Accessed December 10, 2024. https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/diagnosis-treatment/drc-20378561.
      3. Mez J, Daneshvar DH, Kiernan PT, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318(4):360–370. doi:10.1001/jama.2017.8334.
      4. Brain scans of former NFL athletes show a repair protein in place long after initial injury. Johns Hopkins Medicine. Accessed December 10, 2024. https://www.hopkinsmedicine.org/news/newsroom/news-releases/2023/11/brain-scans-of-former-nfl-athletes-show-a-repair-protein-in-place-long-after-initial-injury.
      5. Alouani AT, Elfouly T. Traumatic brain injury (TBI) detection: past, present, and future. Biomedicines. 2022;10(10):2472. doi:10.3390/biomedicines10102472.
      6. Akramova G. The science of brain imaging: techniques and limitations. 2023;13(1):1-2. Accessed December 10, 2024. https://www.jneuropsychiatry.org/peer-review/the-science-of-brain-imaging-techniques-and-limitations-16327.html.
      7. Keener AB. Detecting hidden brain injuries. Nature. Published online August 29, 2024. doi:10.1038/d41586-024-02788-6.
      8. Expert opinion. Anthony Austin. Global Marketing Manager, Medix Biochemica. November 2024.
        8b. Expert opinion. Maria Voutilainen, Medix Biochemica. January 2025.
      9. Study confirms spit testing may help doctors diagnose concussions. Penn State Health News. November 9, 2020. Accessed December 10, 2024. 
      10. Tenovuo O, Janigro D, Sanchez JC, et al. Editorial: biomarkers of brain damage – a complex challenge with great potential. Front Neurol. 2021;12. doi:10.3389/fneur.2021.664445.
      11. Hier DB, Obafemi-Ajayi T, Thimgan MS, et al. Blood biomarkers for mild traumatic brain injury: a selective review of unresolved issues. Biomarker Research. 2021;9(1):70. doi:10.1186/s40364-021-00325-5. https://pennstatehealthnews.org/2020/11/study-confirms-spit-testing-may-help-doctors-diagnose-concussions/.
      12. New smart helmet could spot concussions in real time. Columbia Magazine. Accessed December 10, 2024. https://magazine.columbia.edu/article/new-smart-helmet-could-spot-concussions-real-time.
      13. Shields BJ, Smith GA. The potential for brain injury on selected surfaces used by cheerleaders. J Athl Train. 2009;44(6):595-602. doi:10.4085/1062-6050-44.6.595.
      14. What is the head health initiative? NFL.com. Accessed December 10, 2024. https://www.nfl.com/playerhealthandsafety/health-and-wellness/medical-research/what-is-the-head-health-initiative.