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Abstract
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Despite the marked increase in scientific attention to concussion and mild traumatic brain injury (TBI) in the past decade, the diagnosis and assessment of a concussion remain largely based on subjective symptom reporting. The symptoms of concussion are nonspecific and highly prevalent in the general population. As such, the accurate and timely diagnosis of concussion is a challenge for many clinicians. This challenge is amplified in the setting of sport-related concussion (SRC), in which head injuries are underreported and often unrecognized.1 The identification of an accurate and objective marker of TBI would be useful for improving identification of concussion and making critical return-to-play (RTP) decisions.2
Although many previous studies of brain biomarkers have focused on their value for identifying potentially life-threatening intracranial hemorrhage on head computed tomography scans,3 considerably fewer have examined their value for differentiating individuals with concussion from those without.4 The major challenges to performing these diagnostic biomarkers studies are ensuring that all participants have clinically defined concussion and that they are compared with appropriately matched controls.
These challenges were addressed in the study by McCrea et al,5 who used a prospective case-control design to investigate the association of SRC with 4 serum markers associated with TBI: glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and total tau. In a sample of 264 collegiate athletes with concussion who were compared with 138 individuals who played contact sports and did not have concussion and 102 individuals who did not play contact sports or have concussion as controls, McCrea et al5 identified significant increases in the acute postinjury period in GFAP, UCH-L1, and tau levels, but not NF-L levels, in athletes with concussion compared with preseason baseline levels and both control groups.
Among athletes with concussion, GFAP levels remained elevated compared with baseline at all other measured postinjury points: 24 to 48 hours (median, 41.25 hours after injury), asymptomatic (median, 6.96 days), and 7 days after RTP (median, 21.41 days). Compared with baseline measurements, athletes with concussions also had significantly increased NF-L levels at 7 days after RTP, and NF-L was the only biomarker that was significantly elevated at this time point in a more severely injured subgroup of athletes with loss of consciousness (LOC) or posttraumatic amnesia (PTA). Additionally, ...
Language: en |