Enhancing Acute Concussion Evaluation in Austere Military Facilities: The Integration of Traumatic Brain Injury Whole Blood Biomarkers

Authors

• Jamie N. Wilson, University of LynchburgFollow

Specialty

Military Medicine

Advisor

Dr. James Kilgore

Abstract

ABSTRACT Mild traumatic brain injury (mTBI) remains a major concern for the U.S. military. Evaluation currently relies on the Military Acute Concussion Evaluation 2 (MACE2) and cranial computed tomography (CT) when red-flag symptoms are present, but CT imaging is unavailable at Role 1 facilities (austere, point-of-injury medical clinics that provide immediate triage, basic resuscitation, and limited diagnostic capability), often prompting costly evacuations or host-nation referrals. Recently, FDA-approved whole-blood testing for glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) offers rapid, point-of-care data that may enhance mTBI assessment in austere settings.

A focused PubMed literature review using “GFAP,” “UCH-L1,” and “mild TBI” identified relevant studies published within the past five years. ChatGPT-assisted summaries were reviewed and corrected by the authors. Pediatric studies, articles on long-term biomarker stability, and studies unrelated to acute mTBI were excluded, yielding 15 articles for analysis.

Findings from ALERT-TBI, i-STAT Alinity™ validation trials, and related studies showed GFAP and UCH-L1 sensitivities exceeding 95% with a strong negative predictive value for ruling out CT-detectable intracranial injury within 24 hours. However, low specificity and susceptibility to confounding by other injuries limit their diagnostic accuracy as standalone tests.

Adopting GFAP and UCH-L1 testing at Role 1 facilities could decrease unnecessary CT utilization, reduce radiation exposure, conserve evacuation resources, and improve operational readiness. Future research should focus on enhancing specificity, integrating biomarkers into clinical algorithms, and comparing plasma and whole-blood platforms to optimize their use in deployed environments.

Recommended Citation

Wilson JN. Enhancing Acute Concussion Evaluation in Austere Military Facilities: The Integration of Traumatic Brain Injury Whole Blood Biomarkers. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).