Breakthrough in Evaluation of Brain Injury

Insights provided by Gemma Álvarez and Martina Pavletić

In recent years, there has been increased interest in using biomarkers of brain injury for the evaluation of patients with mild traumatic brain injury (mTBI) in the emergency department. Many of you will be aware that mTBI can result from a blow or jolt to the head or body, which causes the brain to suddenly move inside the skull, resulting in a variety of potential symptoms, including headaches, fatigue, nausea, anxiety, and irritability. In some cases, mTBI can lead to post-concussion syndrome (PCS). 

Currently, computed tomography (CT) scans of the head matched with Glasgow Coma Scale evaluation is the gold standard for evaluating mTBI patients in the acute setting. However, this method has two significant drawbacks. First, it is expensive. Second, approximately 90 percent of patients with mTBI show no tomographic finding (1, 2, 3, 4), meaning that they are exposed to unnecessary radiation. Evidently, there is a need to integrate new diagnostic technologies in emergency departments to improve the evaluation and triage methods for the mTBI population. 

Adoption and implementation of the use of biomarkers of brain injury for mTBI evaluation in emergency departments has resulted in practice improvements. Álvarez’s practice, Hospital Universitario Virgen de las Nieves in Granada, Spain, treats an average of 15 TBI patients per day. Meanwhile, Pavletić’s University Hospital Rijeka in Croatia treats between 3–5 TBI patients per day.

At Hospital Universitario Virgen de las Nieves, the use of biomarkers for mTBI evaluation has brought numerous benefits for patients, physicians, and emergency department administration. An objective test that can rule out mTBI not only increases the physician’s confidence in making decisions that eliminate unnecessary pathways, but also provides reassurance to the patient. As noted above, the elimination of unnecessary CT scans reduces patient exposure to radiation and saves costs for the healthcare system. Since implementing TBI biomarkers, staff have tested 348 patients, 80 of whom a CT scan was not necessary. This has led to a reduction of unnecessary CT scans by 76 percent, and has saved €12,183. Time is also saved; before the introduction of mTBI biomarkers, the average emergency room wait time for a patient with mTBI was eight hours; now, patients with negative mTBI biomarker results are often discharged, dramatically bringing the average wait time down to three hours.

Similar improvements have been seen at University Hospital Rijeka since it became the first hospital in the region to use mTBI biomarkers. The most notable impact is on patient safety, as the blood test helps reduce scans (and therefore radiation) and prevents unnecessary medication and procedures – factors that are especially important for younger and older patients. Like Hospital Universitario Virgen de las Nieves, the use of biomarkers has also reduced the backlog of CT and MRI scan results, making the evaluation process more efficient for both the patient and physician. 

There is a promising future for the use of biomarkers in the area of brain health. Blood biomarkers of the brain are fascinating because they can help us better understand brain injury and how to protect this most precious of organs. We believe that, in the future, the benefits of these blood biomarkers will see application in other fields, such as psychology.

Gemma Álvarez is a doctor who specializes in clinical analysis. She is a member of ibs. GRANADA, and head of the emergency laboratory at Hospital Universitario Virgen de las Nieves, Granada, Spain. 

Martina Pavletić is Internal Medicine, Nephrology and Intensive Medicine Consultant, and Head of ED, CHC, Croatia.