Blood biomarkers for brain
injury in concussed professional ice hockey players
injury in concussed professional ice hockey players
Shahim
P., Tegner Y., Wilson DH., Randall J., Skillback T., Pazooki D., Kallberg B.,
Blennow K., Zetterberg H. JAMA Neurol. 2014; E1-E9.
P., Tegner Y., Wilson DH., Randall J., Skillback T., Pazooki D., Kallberg B.,
Blennow K., Zetterberg H. JAMA Neurol. 2014; E1-E9.
Take Home Message: Biochemical
markers in the blood, like T-tau, are elevated after a concussion and are
associated with recovery time. These markers may eventually be developed into
clinical tools to determine diagnosis and prognosis after concussions as well
as to devise improved return-to-play decisions.
markers in the blood, like T-tau, are elevated after a concussion and are
associated with recovery time. These markers may eventually be developed into
clinical tools to determine diagnosis and prognosis after concussions as well
as to devise improved return-to-play decisions.
Most
concussions heal within days to weeks, but up to 20% of patients have a prolonged
recovery. The danger of developing chronic or progressive concussion symptoms may
be linked to repeated concussions before the brain completely heals. Tools to
detect and monitor the brain during the recovery process, such as biochemical
markers (biomarkers) in the blood, could help us make objective decisions on
whether returning an athlete to play is safe. As a first step in finding a
potential biomarker, the authors compared preseason concentrations (47 players)
of 3 biomarkers (total tau [T-tau], S-100b, neuron-specific
enolase NSE]) to postconcussion concentrations
(27 players) among professional Swedish ice hockey players. Team physicians
collected preseason blood samples from two out of 12 teams in Sweden’s top
professional ice hockey league. Players from one of these teams also provided blood
samples immediately after a friendly game that had no concussions. Any athlete
in the league who sustained a concussion had consecutive blood samples drawn 1,
12, 36, and 48 hours as well as 144 hours after the injury, or the date on
which the athlete returned to unrestricted activity. T-tau levels were
significantly higher at all time points compared with preseason levels. Players
had similar T-tau concentrations after a friendly game compared with preseason
concentrations. In contrast, NSE and S100B were elevated after a friendly game
and S-100b was only elevated immediately after an injury while NSE concentrations
were unaffected by concussions. Levels of S-100b were higher in players that
had loss of consciousness as well as those that took more than 10 days to
return to play. T-tau concentrations 1 hour after a concussion correlated with the
number of days it took for concussion symptoms to resolve. Additionally, T-tau
levels 144 hours after concussion remained significantly elevated in players
with persistent concussive symptoms of 6 or more days compared with those whose
symptoms resolved within 6 days. The authors found that T-tau concentrations 1
hour after a concussion had the highest diagnostic accuracy for detecting
players who developed persistent symptoms for more than 6 days.
concussions heal within days to weeks, but up to 20% of patients have a prolonged
recovery. The danger of developing chronic or progressive concussion symptoms may
be linked to repeated concussions before the brain completely heals. Tools to
detect and monitor the brain during the recovery process, such as biochemical
markers (biomarkers) in the blood, could help us make objective decisions on
whether returning an athlete to play is safe. As a first step in finding a
potential biomarker, the authors compared preseason concentrations (47 players)
of 3 biomarkers (total tau [T-tau], S-100b, neuron-specific
enolase NSE]) to postconcussion concentrations
(27 players) among professional Swedish ice hockey players. Team physicians
collected preseason blood samples from two out of 12 teams in Sweden’s top
professional ice hockey league. Players from one of these teams also provided blood
samples immediately after a friendly game that had no concussions. Any athlete
in the league who sustained a concussion had consecutive blood samples drawn 1,
12, 36, and 48 hours as well as 144 hours after the injury, or the date on
which the athlete returned to unrestricted activity. T-tau levels were
significantly higher at all time points compared with preseason levels. Players
had similar T-tau concentrations after a friendly game compared with preseason
concentrations. In contrast, NSE and S100B were elevated after a friendly game
and S-100b was only elevated immediately after an injury while NSE concentrations
were unaffected by concussions. Levels of S-100b were higher in players that
had loss of consciousness as well as those that took more than 10 days to
return to play. T-tau concentrations 1 hour after a concussion correlated with the
number of days it took for concussion symptoms to resolve. Additionally, T-tau
levels 144 hours after concussion remained significantly elevated in players
with persistent concussive symptoms of 6 or more days compared with those whose
symptoms resolved within 6 days. The authors found that T-tau concentrations 1
hour after a concussion had the highest diagnostic accuracy for detecting
players who developed persistent symptoms for more than 6 days.
This
study demonstrated that there are biochemical changes following a concussive
event that could have diagnostic and prognostic benefits. Future research may
help us determine if biomarkers like T-tau can also serve as an objective
measure to diagnose a concussion. The major finding was that plasma levels of
T-tau increased in ice hockey players that were diagnosed with a concussion. T-tau
may be a better biomarker to continue to investigate since S-100b and NSE may
not be sensitive enough to detect a concussion. This was apparent since both were
elevated after a game with no incidence of concussion, where T-tau did not show
higher levels when a concussion did not occur. Also, T-tau levels measured at 1 hour after
concussion was related with the number of days it took for symptoms to resolve
as well as had the highest diagnostic accuracy when comparing it to
concentration 1 hour after a friendly game. It’ll be interesting to see how
T-tau performs when we compare preseason, post-concussion, and post-friendly
game concentrations from the same athlete. Furthermore, we need to learn if a concussion
injury from several repetitive blows would also change the T-tau concentration.
While more research is required to
establish if T-tau concentrations could help us diagnose a concussion and establish
safe return to play criteria this study shows that this might be feasible.
study demonstrated that there are biochemical changes following a concussive
event that could have diagnostic and prognostic benefits. Future research may
help us determine if biomarkers like T-tau can also serve as an objective
measure to diagnose a concussion. The major finding was that plasma levels of
T-tau increased in ice hockey players that were diagnosed with a concussion. T-tau
may be a better biomarker to continue to investigate since S-100b and NSE may
not be sensitive enough to detect a concussion. This was apparent since both were
elevated after a game with no incidence of concussion, where T-tau did not show
higher levels when a concussion did not occur. Also, T-tau levels measured at 1 hour after
concussion was related with the number of days it took for symptoms to resolve
as well as had the highest diagnostic accuracy when comparing it to
concentration 1 hour after a friendly game. It’ll be interesting to see how
T-tau performs when we compare preseason, post-concussion, and post-friendly
game concentrations from the same athlete. Furthermore, we need to learn if a concussion
injury from several repetitive blows would also change the T-tau concentration.
While more research is required to
establish if T-tau concentrations could help us diagnose a concussion and establish
safe return to play criteria this study shows that this might be feasible.
Questions for Discussion:
Do you think you would be able to get a blood sample 1 hour after the
concussive injury? Do you think your athletes would allow you to take baseline
blood samples if they knew it could help with concussion diagnosis?
Do you think you would be able to get a blood sample 1 hour after the
concussive injury? Do you think your athletes would allow you to take baseline
blood samples if they knew it could help with concussion diagnosis?
Written
by: Jane McDevitt, PhD
by: Jane McDevitt, PhD
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
Shahim, P., Tegner, Y., Wilson, D., Randall, J., Skillbäck, T., Pazooki, D., Kallberg, B., Blennow, K., & Zetterberg, H. (2014). Blood Biomarkers for Brain Injury in Concussed Professional Ice Hockey Players JAMA Neurology DOI: 10.1001/jamaneurol.2014.367
The feasibility of getting a blood sample from a player would be very difficult one hour after a concussion. One of the biggest reasons for that would involve the athlete not having a baseline blood sample measurement prior to the injury. Another issue would involve the number of athletic trainers working at the event. If it is a high school game, having the only athletic trainer on site to do a blood draw without anyone else covering the game would not be beneficial to the rest of the athletes participating. Overall, the concept is a novel idea. However, further research must be done in order to validate the importance of T-tau biochemical marker and a systematic plan to procure and store the blood.
The other consideration involves the athlete allowing blood to be taken as a baseline measurement. A possible objective measurement such as blood samples, if found clinically meaningful, can help clarify the athlete's condition. Further eduction outside of the signs and symptoms of a concussion could help clarify the complexity of a concussion. I would personally feel that an athlete would agree to do baseline blood samples if the research evidence backs baseline blood samples and clinical applications are appropriate for the particular situation.
Alexander-
I agree with you. It would be very difficult to draw blood 1 hour after a concussion, and baseline blood draws would have to be done. If a biomarker such a total tau becomes a valid marker for diagnosis and can help determine return to play care I believe that an athlete/and parent will give consent/assent to allow for the blood draws to be taken. I wonder if the blood draw technology would also be elevated by that time. For example, have a finger prick test similar to how diabetic patient test their sugar. That way it would be quick and easy and you would not have to store anything.