We, more and more frequently, hear news about the danger of concussions for athletes, football players in particular. But many average people suffer from concussions, whether from things like falls or car accidents, and they are frequently misdiagnosed.
In fact, there are 2.2 million emergency visits for traumatic brain injuries (TBI) each year. For that reason, Hennepin County Medical Center in Minneapolis and the University of Minnesota, in partnership with Abbott, have announced the launch of the largest single-center prospective study of TBI in the country.
The goal is to diagnose concussions early enough for clinicians to provide better care, quicker and prevent additional brain damage.
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The study will screen thousands of trauma patients to develop a standard approach for evaluating and diagnosing traumatic brain injury. Researchers will use multiple evaluation tools, including eye tracking, blood-based biomarkers, imaging and cognitive measures. The goal of the study is to use this multimodal approach in the future. This isn’t an interventional study, so it’s not currently being used in real-time to make decisions. The team is assessing the use of a multimodal approach for potential use.
Dr. Beth McQuiston, neurologist and medical director at Abbott shared about the study goals and the general initiative in a phone interview.
So much of the media is focused on concussions occurring for athletes. How does your research look beyond that?
If you look at the occurrence of concussions, the vast majority are not in athletes. In fact, 40 percent of them are due to falls, or next would be motor vehicle accidents. Concussions can happen to anybody, and they usually occur out of the blue with very little warning.
With this study, what is the end goal and what are you really trying to determine in terms of improving treatment?
Our goal is to evaluate everyday people who are coming into the emergency room, children at age 4 up to the elderly, across the spectrum from mild, moderate to severe. We want to see how we can better manage the process.
Abbott has a hand-held portable device that is in one in three hospitals in the U.S., and it performs a number of common blood tests. For example it can be used for those who’ve had heart attacks or are pregnant. So what we would be doing is analyzing a patients blood putting that together with other modality testing. Our goal is to pull these different techniques together to help manage patients.
What shows up in a blood test that indicates a concussion occurred or was detrimental?
If somebody falls and hits their head, we can take their blood, two or three drops on our hand-held device, wait maybe 15 minutes, and if the proteins are there the test will come back as positive. That serves as a warning bell that further evaluation is needed.
We use blood tests all the time, for looking at the heart, the pancreas, the liver, basically every organ in the body, but as a neurologist, it’s about time we had some for looking at the brain.
This study is essentially designed to allow clinicians to be able to diagnose a concussion earlier than they currently are able to?
There will be additional data that will allow them to decide how they can optimize the process. Let’s say someone had a heart attack, they come in, they do multiple testing like an EKG, a blood test, an ultrasound and of course you do a clinical exam. You put all of those things together and look at them comprehensively to help with decision making. That is something that we are exploring in the concussion space.
What are the potential detriments that come from not diagnosing a concussion?
Concussions not being diagnosed is hard. The brain is tricky, and it can be mistaken for something else, like dehydration, a headache or not eating and sleeping well. You can’t treat what you don’t know. Currently, it’s rather subjective. Right now, you would ask a patient some questions to see what their mental status is, you ask them to follow some commands, but you don’t know the base line because you don’t know them. Often times you’ll order a CT scan, but often times they come back negative, and that doesn’t mean they don’t have a concussion. So you can see how it’s currently hard to know whether or not someone has had a concussion.
The other thing, people have a significantly higher chance of having another concussion if they have already had one – particularly within the next 10 days. So people need accurate information to live their life in a safe way and make informed decisions.
How do you treat a concussion?
Rest is the most important thing. An analogy, if someone had a pulled hamstring, you would know to sit them down and prevent re-injury. You’d never ask them to go on a 20-mile hike.
And, arguably, your brain is more important than your hamstring.
How did the collaboration between Abbott and University of Minnesota come together?
Well Dr. Uzma Samadani [neurosurgeon and one of the lead investigators of the study] and I met at a conference, and we had similar research interests. We wanted to work together and waited for the right timing with financing.
The academic cost for this study far pales in comparison to the $77 billion these injuries cost the United States in terms of disability, injury and treatment. Our treatment is taking off and we’re very excited about it.
