New blood test may aid rapid diagnosis of traumatic brain injury

For decades I have  represented people with so-called “mild” traumatic brain injuries. A “mild” traumatic brain injury  (TBI) may be defined as one affecting someone else’s family, not your own.

These typically involve a concussion, with or without a loss of consciousness. Emergency medical personnel and emergency department physicians often focus primarily on more obvious physical injuries. If there are visible and immediately life threatening injuries, broken bones or internal bleeding, that is the focus.

Subtle but life altering brain injuries are easily overlooked. Unless there is a gross brain bleed readily visible on a CT scan of the brain, it may be missed. Microscopic level changes to the brain such as diffuse axonal shearing may not be visible for years, often not until autopsy after death. The dangers of post-concussion syndrome have gained great public attention through the class action for former professional football players whose concussions year ago led to complications such as cognitive impairments, depression, and increased vulnerability to subsequent concussions.

Until now, if there was no gross anatomical injury or brain bleed visible on a brain CT scan, the diagnosis of concussion was often subtle, subjective and easily missed. The standard diagnostic protocol has involved physical examination, a series of screening questions for cognitive and neurological symptoms, e.g., “who is the President,”  and often a CT scan to diagnose TBI.

But while CT scans are currently the  standard of care in checking for acute bleeding or swelling in the brain, nearly 30% of patients with a normal CT scan showed signs of TBI when when doctors follow up with an MRI scan. However, MRI is more expensive, slower to produce reports, and not available everywhere. Missing a diagnosis or waiting days for one could have significant consequences.

However, according to a study published this week in Lancet Neurology, many concussions may be detected quickly with a blood test. The study reports that many patients whose concussions are not detected on CT but are detected on MRI have an elevated level of the brain-specific protein glial fibrillary acidic (GFAP). Thus, elevated GFAP may be used as a biomarker to help physicians detect TBIs.

The study used i-STAT™ Alinity™ device from Abbott Laboratories. This is a handheld, portable blood analyzer that produces test results in minutes by measuring the patient’s GFAP protein level.  Such rapid diagnosis might be able to fill a significant gap in emergency departments, sport fields and battle fields.

The i-STAT Alinity device is available outside of the U.S. and is not yet commercially available in the U.S. If it works out as hoped, and is approved by the FDA, this new test could speed diagnosis and treatment of traumatic brain injuries, reducing the critically important time required for diagnosis and treatment of TBI.


 

Ken Shigley is a 2019 recipient of the “Tradition of Excellence”Award from the State Bar of Georgia General Practice & Trial Section.

Mr. Shigley has earned three national board certifications from the National Board of Trial Advocacy – in Civil Trial Law, Civil Practice Law and Truck Accident LawHe is a board member of the Academy of Truck Accident Attorneys, former chair of the American Association for Justice Motor Vehicle Collision, Highway & Premises Liability Section, which includes the Trucking Litigation Group. 

He is lead author of Georgia Law of Torts: Trial Preparation and Practice, now in its tenth annual edition with Thomson Reuters West. His law practice is focused on catastrophic injury and wrongful death including those arising from commercial trucking accidents and those involving brainneckbackspinal cordamputation and burn injuries. 

In 2011-12, Mr. Shigley was president of the State  Bar of Georgia, which includes all the lawyers and judges in Georgia.  He also is a former chair of the Institute for Legal Education in Georgia (board member 2008-2019, chair 2012-13),  State Bar of Georgia Tort & Insurance Practice Section (1994-95), and the Georgia Insurance Law Institute (1994). 

A former prosecutor and former insurance defense lawyer, Mr. Shigley is a graduate of Furman University and Emory University Law School. He is a widower,  father of two adult children, and an elder in his church.