Research Underway To Improve Diagnosis Of Traumatic Brain Injury

Research carried out at Te Pae Tiaki Wellington ED and the Hutt Hospital ED, with the support of the University of Otago, Wellington, could soon see traumatic brain injuries (TBI) screened for using a blood test without the need for a CT head scan.

TBI are a leading cause of death and disability in New Zealand and range from mild injuries such as concussion, to severe injuries including brain bleeding or swelling. They can be difficult to identify, and ED doctors rely on clinical skills to decide if patients require a CT head scan to rule out a more severe injury.

For more than a year, ED registrar Dr Alice Rogan (pictured) has been conducting a pilot study investigating the use of blood biomarkers as a test to rule out severe TBI.

“Requests for CT scans are increasing, however only around 10 percent patients who have a CT head scan have more severe injuries identified,” Dr Rogan said.

“When the brain is injured, biomarkers are released into the blood stream and can be measured. At this early stage of the research, we are asking patients to consent to have a blood test taken if they require a CT head scan. We then observe how well those biomarkers can predict injuries seen on CT. The patients care in ED does not change. If the biomarkers can predict injuries safely, in future we are aiming to introduce their use into clinical pathways for TBI. If blood biomarker levels are not raised, we would not expect to see any injury on CT, and therefore the new pathway would recommend not to perform a head CT.”

To date, almost 300 people have consented to take part and it is hoped the pilot biomarker data will be available by the end of July – Soon the trial will be expanded to include other EDs in New Zealand with the aim of recruiting 1000 people to the study by 2022.

“No ED in Australasia is currently using biomarkers as part of routine management of TBI. This research will provide novel Australasian data that could lead to the incorporation of biomarkers into ED clinical guidelines.

“If biomarkers are found to safely predict that a patient does not have a more serious injury, it could mean these patients can be safely discharged from ED without waiting for a CT – improving the quality of care patients with TBI receive in ED, reducing patient waiting times, ED workload demand and healthcare costs as well as helping patients who do need a head CT to get one more quickly.”

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