Are you already testing or are you still evaluating?
July 19, 2022 – For the ED, the Glasgow Coma Scale combined with a CT scan is currently the gold standard in the assessment of traumatic brain injury (TBI). In moderate and severe TBI, the assessment of the condition is usually clear, as is the decision to perform a CT scan. Both are much more difficult with mild TBI, which accounts for 90 percent of cases.
In the virtual press conference “Are you already testing or are you still evaluating?” Prof. Peter Biberthaler, specialist in general surgery, specialist in orthopedics and trauma surgery at the Technical University of Munich, gave insights into everyday life in an emergency room. with dr Beth McQuiston, Medical Director Diagnostics at Abbott, he discussed the need for objective diagnostics in mild TBI and, in this context, the new biomarker test “Alinity iTBI” from the global healthcare company Abbott.
Traumatic Brain Injuries – A Silent Epidemic
TBI is the most common neurological disorder worldwide, causing more death and disability than any other traumatic injury. In Germany alone, around 420,000 cases requiring inpatient treatment are recorded every year. Any injury caused by a bump, hit, or concussion to the head—whether with or without a fracture—can result in brain damage. And even minor injuries can cause cerebral hemorrhage or swelling, with symptoms sometimes taking days to appear. The highest rates of TBI are observed in adults over 75 years of age, children under 5 years of age and adolescents/young adults between 15 and 24 years of age. The annual costs for the healthcare system in Germany are around 2.5 billion euros.
Depending on the extent and type of injury, duration of loss of consciousness, post-traumatic amnesia (loss of memory), and level of confusion at the initial assessment of the injury, traumatic brain injury will be evaluated in the emergency department first using the Glasgow Coma Scale (GCS), and then possibly .assigned to the mild, moderate, or severe category using a CT scan.
The World Health Organization Neurotrauma Task Force defines mild TBI as a concussion of the head that causes an acute disruption of brain function, characterized by a brief loss of consciousness (
56 percent of mild traumatic brain injuries are missed on CT
Although mild traumatic brain injury is the most common form of brain injury, accounting for 90% of all cases, diagnosis and treatment remain a major challenge, as computed tomography (CT) scans often misdiagnose or underdiagnose TBI. Beth McQuiston, MD, Medical Director Abbott Diagnostics, stated, “The diagnosis of mild traumatic brain injury was often not made in the emergency department medical records, even though patients reported findings suggestive of mild traumatic brain injury when questioned – let trauma close.”
The measurement of two complementary biomarkers in blood plasma and serum – GFP and UCH-L1 – proved to be even more sensitive than computed tomography in the diagnosis of mild brain injuries. An increased concentration of both proteins indicates a brain injury. If the biomarkers are NOT detectable, it can be assumed with great certainty that there is no injury.
Avoidance of unnecessary radiation exposure
“There is a high demand from the medical community for tests to assess TBI, but the current diagnostic tools for traumatic brain injury have several limitations, such as unnecessary radiation exposure and low sensitivity and specificity,” confirmed Prof. Peter Biberthaler, head of the clinic for trauma surgery at the Technical University of Munich, in the press conference.
Biomarkers to assess mild TBI
The complementary biomarkers GFAP and UCH-L1 have been investigated in numerous studies for their potential role as surrogate markers for imaging in patients with suspected TBI. The combination of GFAP and UCH-L1 has been identified as a potential marker to improve the assessment and clinical management of patients with TBI and provides evidence of the absence of acute intracranial lesions. This combination as a surrogate imaging marker improves overall diagnostic accuracy, reducing unnecessary CT scans in patients with suspected TBI.
Abbott’s Alinity iTBI test for objective assessment of mild TBI
The new Alinity iTBI test measures the biomarkers GFAP and UCH-L1 present in the blood after traumatic brain injury (TBI) within 18 minutes. The test is approved for patients aged 18 and over and provides reliable results within 12 hours of the injury occurring.
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Abbott has been represented in Germany for over 50 years with a wide range of health technology products and services, including in the areas of diagnostics and medical devices.
The company employs almost 4,000 people at eight locations in Germany. Among other things, Abbott has production facilities in Wiesbaden and Neustadt am Rübenberge. The European Distribution Center is also located at the main location in Wiesbaden.
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Sources: 1. https://www.kompetenznetz-vorhofflimmern.de/de, last access on 09.05.2022
2. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014;6:213-220. Published 2014 Jun 16. doi:10.2147/CLEP.S47385
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