Orlando Health Orlando Regional Medical Center researchers show a blood test for traumatic brain injury performs just as well as clinical guidelines, may reduce the need for computed tomography scans

Orlando, Fla. (March 14, 2022) --- A new study by researchers at Orlando Health Orlando Regional Medical Center (ORMC) found a blood test for traumatic brain injury performs just as well as the clinical guidelines emergency medicine physicians use to decide if a patient with a mild traumatic brain injury or concussion needs a computed tomography (CT) scan. The discovery of the high performance TBI biomarkers blood test may improve the detection of brain injuries on CT, while reducing the need for CT scans. The study was recently published in JAMA Network Open, an international, peer-reviewed, open access, general medical journal.

Currently physicians rely on CT imaging to initially evaluate mild traumatic brain injury or concussion.

“Roughly ten percent of patients with so-called mild TBI or concussions can have serious brain injuries on CT scan that require rapid treatment. It is critical to detect these injuries,” said Linda Papa, MD, lead author of the study and emergency medicine physician and director, Academic Clinical Research, ORMC. “This also means that the majority of patients will not need a CT scan. Minimizing exposure to unnecessary radiation from CT scans is also a consideration.”

During the study, participants had a CT scan ordered by emergency physicians based on current clinical guidelines — the Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), and the National X-Radiography Utilization Study II (NEXUS II). The same participants also received the blood test that detects the two FDA-approved biomarkers (GFAP and UCH-L-1) that are present after brain injury. The results of the blood test were compared to these three validated clinical decision rules.

Findings indicate the blood test, the CCHR, and the NOC were each 100 percent sensitive in detecting CT lesions on their own. The sensitivity for NEXUS II was only 83 percent. The study also found the combined use of the test and clinical guidelines improved the accuracy even more. Specifically, the combination of the GFAP biomarker with the CCHR had the highest diagnostic performance of all combinations.

“There is a balance between correctly identify patients with brain injuries on CT scan (the sensitivity) and correctly identifying patients without injuries on CT (the specificity). The best balance came from combining GFAP with the CCHR clinical guideline,” said Dr. Papa. The study also asked physicians, while they were caring for these patients, if they thought testing for biomarkers would be helpful.

“We found that 86 percent of emergency medicine physicians like the idea of having a blood test for patients with mild traumatic brain injury or concussion,” said Dr. Papa. “There was considerable enthusiasm about an objective measure of brain injury. While the biomarkers are FDA approved for mild TBI, the question for clinicians always remains – Is it better than what we currently do?”

A blood test to detect mild traumatic brain injury has been a significant milestone in traumatic brain injury research – critical to diagnosis and treatment for patients.

“Physicians use blood tests in combination with clinical decision making for many conditions like coronary heart disease, kidney disease and diabetes,” said Dr. Papa. “The prospect of having a blood test that could enhance our clinical decision making in patients with mild TBI and concussion is remarkable. This could potentially change the way we treat these patients going forward.”

Researchers at ORMC were leaders in identifying the two biomarkers used in the blood test to detect brain injury and have continued to evaluate different aspects of the blood test through various studies. Previous studies have been published in various publications including Journal of Neurotrama, JAMA Neurology, BMJ Paediatrics Open, Academic Emergency Medicine, and Journal of Trauma.

About Orlando Health 

Orlando Health, headquartered in Orlando, Florida, is a private, not-for-profit healthcare organization with $7.6 billion of assets under management that serves the southeastern United States.

Founded more than 100 years ago, the healthcare system is recognized around the world for its pediatric and adult Level One Trauma program as well as the only state-accredited Level Two Adult Trauma Center in the St. Petersburg region. 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 3,200-bed system includes 16 wholly-owned hospitals and emergency departments; rehabilitation services, cancer and heart institutes, imaging and laboratory services, wound care centers, physician offices for adults and pediatrics, skilled nursing facilities, an in-patient behavioral health facility, home healthcare services in partnership with LHC Group, and urgent care centers in partnership with FastMed Urgent Care. Nearly 4,500 physicians, representing more than 90 medical specialties and subspecialties have privileges across the Orlando Health system, which employs more than 23,000 team members. In FY21, Orlando Health served nearly 160,000 inpatients and nearly 3.6 million outpatients. During that same time period, Orlando Health provided approximately $648 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. Additional information can be found at http://www.orlandohealth.com, or follow us on LinkedIn, Facebook, Instagram and Twitter @orlandohealth.