Serum tau fragments predict return to play in concussed professional ice hockey players
Shahim P., Linemann T., Inekci D., Karsdal MA., Blennow K.,Tegner Y., Zetterberg H., Henriksen K. Journal of Neurotrauma. Epub ahead of print.
Take Home Message: The Tau-A biomarker is a potential biomarker to distinguish those at risk for prolonged recovery following a concussion.
Diagnosis and return to play following a concussion rely heavily on subjective information from athletes. Thus, there is a great need to develop an objective tool, such as a blood test, to diagnose and monitor a concussion. Therefore, the authors evaluated professional Swedish ice hockey players to determine the utility of 2 fragments of tau (tau-A & tau-C) for diagnosis and prognosis of sports-related concussions. The authors compared preseason levels of the tau fragments (47 athletes) to levels 1 hour, 12 hours, 36 hours, and 144 hours after a concussion injury or when the athlete returned to play (28 athletes). Levels of tau-C were higher after a concussion compared with preseason levels. There were no differences between tau-A serum levels between preseason and post-concussion levels. Once both tau-A and tau-C peaked the levels remained the same until return to play. When comparing concussed players that had symptoms resolution within 10 days to players with persistent symptoms beyond 10 days serum tau-A at 1 hour and 12 hours were higher in those with persistent symptoms. There were no tau-C level differences found between players with symptom resolution within 10 days and those suffering from persistent symptoms. The authors found that Tau-A levels at 12-hour post concussion had the highest diagnostic accuracy to discriminate early and late return to play, where tau-C was not able to discern return to play time between the groups.
The authors demonstrated that biomarkers from a blood test following a concussive event could have diagnostic benefits. The most interesting finding was that tau-A levels at 1 hour and12 hours post injury could predict which athlete would return to play within 10 days or later. Measuring tau-A levels could help identify high-risk concussion cases that should be managed with a higher degree of attentiveness. Though tau-C levels were higher following concussion, levels remained the same until return to play. However, tau-C may be used to discriminate if a player has a concussion or not, but more research is needed. Together a blood test measuring tau-C and tau-A levels could assist medical professionals with concussion diagnostic and prognostic accuracy, respectively. More research is necessary to validate the diagnostic accuracy of tau-A; since the pre-season and post concussion levels were measured in 2 different groups of players. However, biomarkers could help establish diagnostic and safe return to play criteria following a sports-related concussion.
Questions for Discussion: Do you think a biomarker panel would be a useful concussion tool? Do you see most of your concussed athletes within 12 hours following injury?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban