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Male and female differences in concussion blood test: New research shows males have a higher elevation of a biomarker used to detect mild traumatic brain injury compared to females

September 21, 2023

Orlando, Fla. (September 21, 2023) – New research shows male patients with mild traumatic brain injury (TBI), or concussion have a higher elevation of a biomarker used to detect the condition, compared to female patients with the injury. The study, led by researchers at Orlando Health Orlando Regional Medical Center (ORMC) and recently published in Nature Journal, is among the first and largest studies to compare the two biomarkers between sexes among trauma patients at the time of diagnosis and over time. The findings will help the diagnosis and treatment of patients with concussion.

The elevated biomarker, ubiquitin C-terminal hydrolase (UCH-L1), is one of two biomarkers already approved by the Food and Drug Administration to detect mild and moderate TBI. The second biomarker is glial fibrillary acidic protein (GFAP).

Although both GFAP and UCH-L1 were able to detect brain injuries on computerized tomography (CT) scan, male patients had a significant higher level of UCH-L1 compared to female patients. UCH-L1 concentrations were about 50 percent higher in male than female patients, particularly in those without brain injuries on CT scan. This difference was not found with GFAP.

The study enrolled male and female patients at the Level One Trauma Center at Orlando Health ORMC. Of the 584 patients, 362 were male and 222 were female.

Comparing biomarkers between males and females will help improve patient care – diagnosis and treatment.

“Since these biomarkers are now commercially available for clinical use it is important to assess their performance for any differences that may exist between male and female patients,” said Linda Papa, MD, lead author of the study and emergency medicine physician and director, Academic Clinical Research, Orlando Health ORMC.

“We are in the early stages of introducing GFAP and UCH-L1 into clinical practice and these differences can help clinicians interpret the tests more accurately. Cutoff levels of UCH-L1 used to decide whether patients need a CT scan or have a concussion may need to be adjusted for male and female patients.”

Understanding the ways medical conditions contrast among male and female patients has also proven beneficial in other areas of health care.

“Just as we’ve learned about recognizing the differences between male and female patients in the management of heart disease, these findings highlight the importance of a sex-specific approach for blood testing for mild traumatic brain injury,” said Dr. Papa.

Researchers at Orlando Health ORMC were leaders in identifying GFAP and UCH-L1 – the two FDA-approved biomarkers used in blood testing to detect brain injury and have continued to evaluate different aspects of the biomarkers through various studies.

Dr. Papa, who has over 20 years of experience in traumatic brain injury biomarkers research, has been the lead author of many studies published in various publications including JAMA Network Open, JAMA Neurology, BMJ Paediatrics Open, Annals of Emergency Medicine, Academic Emergency Medicine, and Journal of Trauma. Dr. Papa has published more than 200 articles related to traumatic brain injury.


About Orlando Health

Orlando Health, headquartered in Orlando, Florida, is a not-for-profit healthcare organization with $9.2 billion of assets under management that serves the southeastern United States and Puerto Rico.

Founded more than 100 years ago, the healthcare system is recognized around the world for Central Florida’s only pediatric and adult Level I Trauma program as well as the only state-accredited Level II Adult Trauma Center in Pinellas County. It is the home of the nation’s largest neonatal intensive care unit under one roof, the only system in the southeast to offer open fetal surgery to repair the most severe forms of spina bifida, the site of an Olympic athlete training facility and operator of one of the largest and highest performing clinically integrated networks in the region. Orlando Health has pioneered life-changing medical research and its Graduate Medical Education program hosts more than 350 residents and fellows.

The 3,888-bed system includes 29 hospitals and emergency departments – 24 of which are currently operational with five coming soon. The system also includes nine specialty institutes, more than 100 adult and pediatric primary care practices, skilled nursing facilities, an in-patient behavioral health facility under the management of Acadia Healthcare, and more than 60 outpatient facilities that include imaging and laboratory services, wound care centers, home healthcare services in partnership with LHC Group, and urgent care centers in partnership with FastMed Urgent Care. More than 4,750 physicians, representing more than 100 medical specialties and subspecialties have privileges across the Orlando Health system, which employs more than 27,000 team members and more than 1,200 physicians.

In FY22, Orlando Health served nearly 142,000 inpatients and 3.9 million outpatients. The healthcare system provided more than $782 million in total value to the communities it serves in the form of charity care, community benefit programs and services, community building activities and more in FY 21, the most recent period for which this information is available. Additional information can be found at, or follow us on LinkedIn, Facebook, Instagram and Twitter @orlandohealth.

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