Testing blood for biomarker may help doctors diagnose brain trauma in children

American Football played by young men

The Brain Injury Association of America estimates that 2.4 million children and adults in the United States suffer some type of traumatic brain injury (TBI) each year, and according to the Centers for Disease Control and Prevention (CDC), TBIs are a leading cause of death and disability among American children and young adults. Doctors have no test other than CT, or CAT, scans to objectively detect and measure the severity of these injuries, but emerging research suggests a blood test may one day make that possible.

Researchers at Orlando Regional Medical Center, in Orlando, Fla., found the biomarker glial fibrillary acidic protein (GFAP) was significantly elevated in the blood of young patients whose brain scans indicated lesions, a sign of mild and moderate TBIs (MMTBIs). They also found a link between individuals reporting MMTBI symptoms and a higher elevation of GFAP in their blood. Study authors said their results suggest blood tests for GFAP could help doctors evaluate injury without exposing youths to potentially harmful radiation from CT scans. And, if brain trauma has occurred, the GFAP level could indicate how severe the injury is, thus helping doctors prescribe the most appropriate treatment.

Overall, the blood test was 94 percent accurate at predicting a TBI six hours post-injury, the time frame during which blood samples were drawn in the study.

“One of the key things we were excited about was even in children who were very young, the biomarker was still helpful in detecting injury,” lead study author Dr. Linda Papa, emergency physician at Orlando Regional Medical Center, told FoxNews.com. “When we see children who can’t speak and tell us how they feel, having a blood test that can speak for the child and tell us how severe the injury is— that would help us so much.”

Mild and moderate traumatic brain injuries (MMTBIs) can occur due to a mild or severe blow during contact sports like football, soccer, lacrosse, basketball and cheerleading. Other research suggests concussions, or mild TBIs, can increase the risk of further injury, as well as lead to memory loss and permanent anatomical changes to the brain.

Papa’s previous analysis of GFAP includes an animal study and a comparable model on adults, both of which produced results similar to the youths and children study. That study involved 257 children and youths drawn from two pediatric ER departments. Of those, 197 had blunt head trauma with or without symptoms, and 60 were controls who did not have brain trauma.

“We had patients who had other types of trauma to make sure that the biomarker was specific to this brain injury,” Papa said.

Dr. Wayne Gordon, the Jack Nash Professor and vice chair of the department of rehabilitation medicine at the Icahn School of Medicine at Mount Sinai, said the study’s findings were interesting  and that they merit further research, namely on how the level of GFAP changes beyond the six-hour mark post-injury. Gordon was not involved in Papa’s study.

”But on the other hand, you don’t have any real sensitive tool for diagnosis [of MMTBIs],” Gordon told FoxNews.com. “So that’s where this blood test could become helpful— because if it’s found to be sensitive in a very large sample of young children, it could ultimately eventually replace CT scans or be used in conjunction with CT scans. If you had a positive finding, you’d know it was a bleed, and you’d want to use a CT scan.”

Dr. Samuel Browd, pediatric neurosurgeon and associate professor of neurological surgery at the University of Washington, as well as the director of the concussion program at Seattle Children’s Hospital, agreed with Gordon. Browd, who also was not involved in Papa’s study, noted that the test likely wouldn’t replace brain scans to test for more moderate or severe brain trauma, but it would help inform hospital staff for patients’ treatment.

“I think the value of the study is trying to use it as a negative predictor essentially to say if you had a lab study that was negative, you might be able to avoid doing a CAT scan,” Browd, who has worked as an unaffiliated neurological consultant with the National Football League (NFL), as well as an independent neurological consultant for the Seattle Seahawks, for the past three years, told FoxNews.com.

He said the finding wouldn’t benefit concussion, or milder TBI, patients whose GFAP levels would presumably be the lowest and whose brain scans often come back negative for lesions anyway. Doctors rely solely on reporting of symptoms from those patients and their caregivers. Emerging methods like diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rsfMRI) appear to be more promising techniques for picking up brain alterations in early-phase concussions, Browd noted.

“It’s not a pure study for concussion if that was sort of their aim,” Browd said, “but it certainly can inform future studies by looking at a larger population. I think it’s of value and informs next steps.”