Mild traumatic brain injury is a common presentation to the emergency department, with current management often focusing on determining whether a patient requires a CT head scan and/or neurosurgical intervention. There is a growing appreciation that approximately 20%–40% of patients, including those with a negative (normal) CT, will develop ongoing symptoms for months to years, often termed post-concussion syndrome. Owing to the requirement for improved diagnostic and prognostic mechanisms, there has been increasing evidence concerning the utility of both imaging and blood biomarkers.
Blood biomarkers offer the potential to better risk stratify patients for requirement of neuroimaging than current clinical decisions rules. However, improved assessment of the clinical utility is required prior to wide adoption. MRI, using clinical sequences and advanced quantitative methods, can detect lesions not visible on CT in up to 30% of patients that may explain, at least in part, some of the ongoing problems. The ability of an acute biomarker (be it imaging, blood or other) to highlight those patients at greater risk of ongoing deficits would allow for greater personalisation of follow-up care and resource allocation.
We discuss here both the current evidence and the future potential clinical usage of blood biomarkers and advanced MRI to improve diagnostic pathways and outcome prediction following mild traumatic brain injury.
- craniocerebral trauma
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Handling editor Richard Body
Twitter @vfjn2, @danw1310
Contributors VN and FL conceived the idea for this article. The manuscript was drafted by VN with input from SR, DPW and BMB. All authors revised subsequent drafts. All authors approved the final submitted version. VN is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. VN is supported by an NIHR Advanced Fellowship and was supported by an Academy of Medical Sciences/The Health Foundation Clinician Scientist Fellowship during the writing of this work. SR is supported by a Wellcome Trust Doctoral Fellowship. DPW is supported by a Royal College of Emergency Medicine Doctoral Fellowship. FL receives renumeration as a research director for TARN, which is funded through member NHS hospitals and hospitals in Ireland by recurrent annual subscription.
Disclaimer The head injury: assessment and early management guideline referred to in this article was produced by the National Institute for Health and Care Excellence (NICE). The views expressed in this article are those of the authors and not necessarily those of NICE.National Institute for Health and Care Excellence (2023) Head injury: assessment and early management. Available from https://www.nice.org.uk/guidance/ng232.
Competing interests VN holds a grant with ROCHE Pharmaceuticals. VN was a member of the Update Committee for the NICE head injury: assessment and early management guideline and represented the Royal College of Emergency Medicine to review the UK Concussion Guidelines for Grassroots Sport. FL was Topic Advisor for the NICE head injury: assessment and early management guideline.
Provenance and peer review Not commissioned; externally peer reviewed.