Clinical utility of concussion injury biomarkers

C.E. Credits: P.A.C.E. CE Florida CE
Speaker
  • Associate Professor, Department of Clinical Laboratory Science, College of Health Professions, Upstate Medical University
    Biography

      Paul R. Johnson, Ph.D., MT(ASCP), D(ABCC), FAACC is an Associate Professor at Upstate Medical University in Syracuse, New York, where he teaches laboratory medicine courses in clinical biochemistry and statistics. He earned a Ph.D. degree in Biochemistry & Molecular Biology from the University of Louisville (KY) School of Medicine, and completed a medical technology fellowship in the Department of Pathology at Newton-Wellesley Hospital (MA). Dr. Johnson’s professional career in clinical pathology spans over 20 years. He has held positions in clinical chemistry, hematology, and immunology laboratories as a medical laboratory scientist; technical specialist at the College of American Pathologists (CAP); and was technical manager of a specialized diagnostic laboratory with focus on cardiovascular disease biomarker testing. At Upstate Medical University, his clinical research has focused on diagnostic utility of concussion injury biomarkers in human subjects, with secondary focus on applied statistics related to human biological variation. His work led to invited presentations at several clinical science conferences, along with recent publications on these topics in high-impact scientific journals including Clinical Chemistry and PLoS One.  He serves as peer-reviewer for several leading journals in the laboratory medicine field. Dr. Johnson holds professional board certifications from the American Society for Clinical Pathology and the American Board of Clinical Chemistry. In 2019, he was inducted as a Fellow into the Academy of the American Association for Clinical Chemistry.


    Abstract

    Cases of traumatic brain injury (TBI) have been steadily rising over the past decade with most common causes of injury observed among participants in contact sports, combat military personnel, and unintentional falls occurring in children and the elderly. These events can range from mild-to-severe injury in the affected individual. Brain imaging using computed tomography (CT) scan is the current gold standard for TBI testing and diagnosis. Mild TBI (mTBI), or concussion injury, is often the most difficult of these to detect because injury to the head region may not be observed on CT scan. Furthermore, CT scanners are not readily available outside of medical institutions. Functional scoring methods, like SCAT5 and Glasgow Coma Scale, may provide the clinician with some evidence of TBI at off-site locations (e.g., on the sports field or in combat zones). Biomarker testing for evidence of TBI has gained popularity as another means towards achieving a reliable diagnosis. A goal of this presentation is to describe TBI, summarize serum biomarkers tests that are used in both clinical and research settings, and suggest alternative means of test interpretation. Concussion biomarkers have shown good promise for ruling out injury (high negative predictive value), while positive test results are often equivocal. The classical way to interpret a biomarker test result is by comparing it to a population-based reference interval established in healthy individuals; the so-called “normal range”.  A potential remedy to improve positive diagnoses is to establish an individual’s own baseline concentration, then compare it with that person’s biomarker concentration after suspected TBI. Serial sampling is used to describe the comparison of two consecutive test results from separate blood draws. Establishing normal biological variation of the biomarker, along with statistical calculation of a “reference change value”, offers an alternative diagnostic strategy for interpreting serial sampling results.

    Learning Objectives:

    1. Identify current diagnostic tools for assessment of acute concussion/traumatic brain injury (TBI)

    2. Describe clinical utility of serum biomarker proteins for detecting concussion injury in human subjects

    3. Discuss serial sampling strategy, and reference change value (RCV), to identify a significant change in biomarker test results


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