A blow to the head can just leave you with a ringing headache, or with something that's far more sinister--a traumatic brain injury with bleeding deep inside that needs surgery. It's hard for doctors in emergency rooms to tell which is which, especially when bleeds are so small they are hard to spot with a CT scan. If a brain injury is missed, the brain can swell, leading to "second impact syndrome," which can be fatal. A blood biomarker found in a study in The Journal of Trauma and Acute Care Surgery could lead to a blood test that would find those patients who have hidden brain injuries, and allow them to get the treatment they need.
"Some of these patients actually go home and they don't feel quite right," Dr. Linda Papa, an emergency physician and director of research for Orlando Regional Medical Center in Orlando, FL, told Postmedia News. "They're forgetful. They have trouble concentrating. They become very anxious, and they don't know why. Everybody tells them: 'You're fine. Your CT scan was fine.' And so they're not offered therapy. There's really no approved blood test for the brain as we know it right now."
The researchers focused on a protein in the blood, ubiquitin C-terminal hydrolase (UCH-L1), in 96 patients who had a blow to the head with loss of consciousness (traumatic brain injury), 23 people with broken bones but no head injury, and 176 people with no injuries.
Some earlier biomarker research had found proteins that were simply related to bone damage, and so could not differentiate between head injury and other injuries. This blood test showed increases in levels of UCH-L1 within an hour of brain injuries, but not in the people with other injuries, or with no injuries. The levels of protein tied in with the levels of injuries seen in CT scans, with the highest levels in patients who needed the most urgent surgery.
This test, if it reaches the market, perhaps even within 5 years, would reduce the number of missed injuries, as well as cut the number of repeat scans needed, which will save money and reduce radiation exposure to both staff and patients.