As concern grows over long-term concussion damage among professional athletes, parents worry about the risks of enrolling their children in high-contact sports, such as little league football. Indeed, while the physical symptoms of concussion are brief, cognitive issues such as irritability and learning impairments can both appear later and last longer. Additionally, while current guidelines for the evaluation of concussion severity are based on duration of clinical symptoms, many unseen effects persist, such as decreased blood flow to the brain and unseen lesions, which can result in increased incidences of schizophrenia, depression, stroke, and even premature death.
Currently, concussions in children are diagnosed based on provider patient history and physical exam. Physicians evaluate the mechanism of injury, duration and the presence of certain key symptoms. Symptoms that are taken into consideration include loss of consciousness, headache, dizziness, seizures, blurry vision, or change in mental status. The gold standard for evaluation of head injury is a CT scan. However, in cases where there is low suspicion of any skull fractures or intracranial bleeding, CT scans may do more harm than good. The radiation from CT scans has been known to cause DNA damage in brain cells and risk of cancer, not to mention the fact that CT scans are extremely expensive. Additionally, in certain areas, a CT scanner may not be readily accessible, and the decision to obtain the scan itself is subjective and provider dependent.
Researchers are developing a new blood test that may one day remove the need to obtain a head CT in order to diagnose the presence and severity of a concussion. This study, conducted by Linda Papa, et al., evaluated the association between serum glial fibrillary acidic protein (GFAP) and lesions on CT scans in children who had been diagnosed with concussions based on their physical symptoms. GFAP is a protein found in the brain surrounding neurons, specialized cells that transmit nerve signals from the brain throughout the body. Scientists believe that when neurons are damaged during injury, GFAP proteins enter the bloodstream. The study found that levels of serum GFAP were significantly higher in those with corresponding lesions seen on CT when compared with patients who did not have identifiable CT lesions.
Image source: SERGEI SUPINSKY / Staff
While more research is required to validate the utility of GFAP, the notion of serum markers to detect the severity of traumatic brain injury is extremely promising. Not only would it reduce the amount of radiation exposure in children, but a single blood test would be more readily accessible, cost effective, and would create a universal standard for concussion diagnosis.