Biomarkers used to detect traumatic brain injury on the spot
A new method for detecting traumatic brain injury (TBI) at the point of care has been developed by scientists at the University of Birmingham, who are using chemical biomarkers released by the brain immediately after a head injury occurs to pinpoint when patients need urgent medical attention. Described in the journal Nature Biomedical Engineering, the technique saves time in delivering vital treatment and avoids patients undergoing unnecessary tests where no injury has occurred.
According to the charity Headway, around 1 million people each year will visit A&E following a head injury. Current methods of assessing TBI frequently rely on the Glasgow Coma Scale, in which clinicians make a subjective judgement based on the patient’s ability to open their eyes, their verbal responses and their ability to move in response to an instruction.
“The current tools we use to diagnose TBI are really quite old-fashioned and rely on the subjective judgement of the paramedic or the emergency doctors,” said study leader Dr Pola Goldberg Oppenheimer. “There’s an urgent need for new technology in this area to enable us to offer the right treatment for the patient, and also to avoid expensive and time-consuming tests for patients where there is no TBI.”
The new method works using a spectroscopic technique called surface-enhanced Raman scattering, in which a beam of light is ‘fired’ at the biomarker. The biomarker, taken from a pin-prick blood sample, is prepared by being inserted into a special optofluidic chip, where the blood plasma is separated and flows over a highly specialised surface. The light causes the biomarker to vibrate or rotate and this movement can be measured, giving an indication of the level of injury that has occurred.
To produce the level of accuracy required, the test needs to be extremely sensitive, rapid and specific. The team developed a low-cost platform, made from polymer and covered with a thin film of gold. This structure is then subjected to a strong electric field, which redistributes the film into a distinctive pattern, optimised to resonate in exactly the right way with the light beam.
The researchers assessed 48 patients using the engineered device, with 139 samples taken from patients with TBI and 82 from a control group. The study showed that in the TBI group, the levels of the biomarker were around five times higher than in samples taken from the control group. The team also found the levels tailed off rapidly around one hour after the injury occurred, further highlighting the need for rapid detection.
“This is a relatively straightforward and quick technique that offers a low-cost but highly accurate way of assessing traumatic brain injury which up until now has not been possible,” Dr Goldberg Oppenheimer said.
Following a proof-of-concept study, the group has now completed Innovate UK’s commercialisation program, ICURe, to identify commercialisation routes for the technique, identifying potential partners across eight countries. The next step will be to miniaturise the technology used to analyse the samples, so that it could be easily stored onboard an ambulance for use by paramedics, used at sporting events where head injuries can be hard to detect, used at local GP services or used in hospitals where it could monitor patients over time to see how the head injury is progressing.
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