Elyse Watkins, DHSc, PA-C, DFAAPA
Mild traumatic brain injury (mTBI), or concussion, is a common occurrence in both the layperson and sports setting, yet the diagnosis of mTBI has typically been a diagnosis of exclusion. Repeated mTBI can lead to long term neurological symptoms, and accurate and rapid diagnosis of mTBI is crucial for appropriate treatment. Recently, two biomarkers have been approved for use in diagnosing acute mTBI: glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolast-L1 (UCH-L1). Other biomarkers have also recently been the topic of multiple studies for the diagnosis of mTBI: microRNA and neurofilament light protein (NF). Based on these new data for novel diagnostic tests, a review of the available trials has been completed to summarize findings and suggest areas of future research. Fifteen studies were reviewed. After thorough review, GFAP was confirmed as being an appropriate diagnostic tool for acute mTBI, but it was lacking in predictive ability. Conversely, UCH-L1 was shown to only be appropriate if no other orthopedic injuries are sustained with an mTBI. Studies for microRNA demonstrated both diagnostic and predictive capabilities of acute mTBI. Lastly, NF studies yielded contradictory reviews, strongly lowering the support for its use for diagnostic or predictive capabilities for mTBI. Based on these findings, continued use of GFAP is suggested, and microRNA is strongly recommended as a beneficial area of future research.
Monaghan BP. Diagnosis of Exclusion No Longer: Literature Review of Trials Utilizing GFAP, UCH-L1, MicroRNA, and Neurofilament Light Protein for the Diagnosis of Mild Traumatic Brain Injury. Lynchburg Journal of Medical Science. 2021; 3(2).
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