MTBI Diagnostic Methods
Several methods currently in use or in development to treat mild traumatic brain injury (mTBI), also known as a concussion, include the Banyan Brain Traumatic Indicator; the Glasgow Coma Scale; CT and MRI imaging tests; neuropsychological evaluations; blood tests conducted on mHealth platforms; and long noncoding RNAs.
current diagnostic methods
Banyan Brain Traumatic Indicator (BTI)
- In February 2018, the Food & Drug Administration (FDA) approved a blood test called the Banyan BTI to be used for the diagnosis of mTBI. Within 12 hours of a concussion, two proteins, ubiquitin carboxy-terminal hydrolase-L1 and glial fibrillary acidic protein, are released into the blood and the Banyan test is looking for those proteins. The test can be used to predict which patients would benefit from receiving a CT scan.
- In a clinical study for the test, the Banyan BTI accurately predicted the presence of intracranial lesions 97.5% of the time, and correctly predicted no lesions 99.6% of the time. Therefore, the test can be used to reduce the number of CT scans that are done.
Glasgow Coma Scale
- According to the FDA, the Glasgow Coma Scale is used with most patients that have a suspected head injury. The test uses a 6-level scale for motor response, a 5-level scale for verbal response, and a 4-level scale for eye-opening. The results are added together and the patient is then categorized into Mild (a score of 13-15), Moderate (a score of 9-12), Severe (a score of 3-8), or Vegetative (a score of less than 3).
- The areas looked at on the Glasgow Scale are designed to determine the social capability of the patient as well as their dependence on others.
- The scale was first published in 1974 and began being widely used during the 1980s.
- Both computerized tomography (CT) scans and magnetic resonance imaging (MRI) are used when there is a suspected brain injury. A CT scan is usually done first, and MRIs are more often used as a secondary test if symptoms don't improve.
- A CT scan is a series of x-rays that allow for a detailed look at the brain. This test can detect issues such as bleeding in the brain, fractures, brain contusions, and swelling.
- An MRI uses radio waves and magnets to view the brain. However, a study published in 2019 found that MRIs are not generally helpful in diagnosing concussions in children.
- A neuropsychological evaluation allows a doctor to evaluate any cognitive or functional deficits that are presented after an injury. This evaluation is typically an interview of the patient and others who know the patient, if possible. The evaluation considers symptoms, behavioral changes pre and post-injury, and patient reported complaints.
- Some areas of cognitive function that are examined during the evaluation include "attention, processing speed, executive functions, and/or memory."
IN-DEVELOPMENT TESTING METHODS
- Abbott and the United States Defense Department are beginning the process of conducting clinical trials on a blood test that can be done on an mHealth platform within minutes of an injury. The test would be looking for proteins that are released into the blood following an injury that causes a concussion. The hope is that the clinical trial will lead to developing a mobile device that could scan a blood sample wherever needed in order to diagnose a potential concussion.
- This test is designed to improve on the Banyan BTI test by allowing for testing to happen anywhere. The results of this trial will be compared to the other assessments used for detecting mTBIs, such as CT scans and MRIs.
Long noncoding RNAs (lncRNAs)
- lncRNAs are molecules that are specific to various tissue, and may "leak out of a cell when it is injured."
- Daniel Lim and Geoffrey Manley are researchers at the University of California San Francisco who are researching how a blood test can be used to identify the lncRNAs specific to the brain in order to identify brain injuries immediately after they happen.
- The researchers are hoping that the lncRNA markers will be more sensitive than proteins that are currently being tested for, which would allow for the diagnosis of even mild concussions that may currently be missed.