Co-authored by Uzma Samadani M.D., Ph.D., neurosurgeon at Hennepin County Medical Center in Minneapolis
It’s easy to think of a concussion as solely a sports injury when stories of sidelined football, hockey, basketball players and other athletes dominate the headlines. Collegiate and professional athletes are garnering support from their sports leagues, which are working to step up and help their injured players who must cope with the effects of traumatic brain injury. This is good to see. But concussion doesn’t just affect these high-profile athletes. There are millions of untold stories of everyday people who incur concussions while going about their regular routines – tripping while walking, falling off a ladder or down the stairs or kids playing on the playground.
According to the Centers for Disease Control and Prevention (CDC), concussions from slips and falls constitute more than 40 percent of all concussions, which are estimated to account for 4.8 million emergency room visits for traumatic brain injuries (TBI) each year. In fact, findings from a recent study announced today showed diagnoses of concussion in the U.S. jumped 43 percent from 2010 to 2015.
While these stats are staggering and bring to light the seriousness of brain injury, unfortunately there are still many cases of concussion that go undiagnosed and untreated.
That’s because unlike most other medical conditions, there is not an objective tool that can detect mild brain injury. Many concussions are difficult to identify, and current methods of diagnosis are often not absolute – even imaging scans can miss mild concussions. Consider for a moment a person who thinks they might have a strep throat infection. He or she could have a range of symptoms, such as difficulty swallowing, headache or fever, but can’t be sure if it’s a common cold. By going to see a health care provider to get a rapid strep test, he or she can conclusively find out whether it’s strep or something else. This is not the case with current concussion diagnosis methods.
Across the country, concussion diagnosis protocols vary from sport to sport, doctor to doctor, and hospital to hospital. Depending on these protocols and the perceived severity of an injury, patients might receive imaging scans, subjective questions-and-answers or eye-movement tests. But these tests alone only show a fraction of what’s happening inside the brain.
There aren’t widespread, established evaluation protocols for someone with a suspected brain injury like there are for patients suffering a possible heart attack, where they are given a combination of blood tests, EKGs and stress tests to paint a picture of what’s happening to inform treatment.
This is one reason why Hennepin County Medical Center and Abbott are working together on the largest, single-center study of concussion in the country with the goal of helping classify and improve diagnosis of brain injuries. The study will combine a variety of tests — including eye tracking, MRI imaging and blood biomarkers analysis — to evaluate and paint the broader picture of concussion and how it can best be identified and treated.
Each of these tests tells a different part of the story. Eye tracking maps the position of a patient’s pupils, connecting abnormal eye movement with injury. MRI imaging looks at structural problems that are often overlooked by CT scans. Specific biomarkers (measurable medical signs that suggest a disease, injury or other condition) or proteins in blood samples could also indicate injury and serve as a warning bell that further evaluation is needed. Abbott is also working to develop a portable blood test to help detect specific proteins in the blood associated with brain injury.
None of these methods can individually show the full extent of a brain injury. But together, they can give medical professionals an objective, more comprehensive understanding of their patient’s brain health, so they can identify the type of treatment needed. This study aims to develop a multi-step process for concussion diagnosis and standardize how head injuries are detected and treated. It is also a first step toward developing pinpointed, individualized treatments for brain injuries. Once concussion diagnostics are more reliable, the door opens for development of much-needed therapeutic treatments.
Despite tremendous efforts to prevent concussions, these types of injuries are not going away – leaving the medical community in need of a common protocol. This study, and others like it, can help us and other doctors better understand concussions and the medical markers we can use to help evaluate diagnose and treat our patients. While concussion awareness is and always will be important, it’s also vital that everyone – hospitals, academia, health care companies, government and military, and sports organizations – work together to find a solution for the millions of people affected by brain injury ranging from toddlers to grandparents to elite athletes.
Beth McQuiston, M.D., neurologist and medical director at Abbott, and Uzma Samadani M.D., Ph.D., neurosurgeon at Hennepin County Medical Center, are collaborating on the nation’s largest, single-center prospective study on concussion and traumatic brain injury.