Diagnosing TBI in the ER
For mild TBIs, making a clear diagnosis can be difficult. There are CT scans and physical and neuropsych evaluations. But in the future there may be simple, revealing blood tests.
This is an excerpt from BrainLine's webcast After the Injury: Acute Care and TBI. See full webcast here.
Okay, is it easy to tell if a person has a brain injury? I mean, what are you looking for? That's a very good question. When someone comes in in a coma, it's more obvious that they have a brain injury. [Jeffrey Bazarian, M.D.] [Emergency Medical Physician] Their brain is not working because they're not awake, so our physical exam, it just helps us confirm how severe that is. But at the milder end of things, at the concussion end of things, it is difficult to know whether someone's had an underlying brain injury. Honestly, the tools that we have in the emergency department to understand that, to figure that out, are pretty limited. Well, what are some of the tools that you use to detect a brain injury, and then how effective are they? Good questions. We have really 2 main tools to detect a brain injury, and I'm talking more now at the milder end of things. One is our physical exam, so kind of our diagnostic acumen, and that's pretty limited, though, because concussion patients look like we all do sitting here, look pretty awake and alert. Normally, the physical exam is not revealing. A CAT scan, which is a picture of the brain, is also a fairly crude tool for seeing the nerve cells we suspect are injured. And most of the time, people with a concussion have a normal looking CAT scan, so it doesn't really help us in that regard. Is there anything on the horizon that could improve your ability to detect a brain injury in the ER? Yes, there is. It appears that when people have had a concussion, there are some proteins that may be released when the nerve cells get damaged that find their way into the blood. We could take a sample of blood from a patient's arm and tell them whether some of those proteins are in the blood, and that will help us know whether they have had a brain injury. There's at least 1 test being used in Europe in this regard. It's called S100B, and there are many groups in the United States that are studying it now, and I think in the future you're going to be seeing blood tests being used to help diagnose brain injury just like blood tests are used now to figure out if you've had a heart attack.
Posted on BrainLine December 1, 2011.
Dr. Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center.