Researchers from the University of Queensland are attempting to develop a new blood test that would have global implications for identifying and diagnosing a concussion.
The research project is a partnership between the University of Queensland, World Rugby, Rugby Australia, Qscan, Trajan and Sonic Health.
To identify biomarkers in the blood that are indicative of a concussion, the project will employ advanced brain imaging, cognitive testing and blood analysis and will involve testing on volunteers involved in high school rugby and basketball.
Lead researcher of the project, Assoc. Prof. Fatima Nasrallah from the Queensland University said in a news release that a blood test, which can identify a concussion, would have global implications for the realm of sport.
“If we can find a biomarker that accurately reflects how the brain responds to and recovers from a concussion, it will be a game-changer for the sport,” Nasrallah said.
“We could then develop a field‐side tool to inform diagnosis and the action needed in real‐time, such as removing players from the field or returning only when it is safe to do so.
“Ultimately, if we identify a biomarker and develop an easy, point‐of‐care tool that can rigorously diagnose concussions on the sideline or in the clinic, we will help improve the safety of school, community and professional sport.”
Associate Prof. Eva Valera, from Harvard Medical School, wrote in a Harvard Health Blog that the concussion blood tests would look to measure substances, such as proteins and enzymes that are released into the blood when the brain suffers an injury.
Valera said that concussion blood tests could be used to avoid unnecessary imaging scans, which are expensive and expose the body to radiation, without missing a serious brain injury. They also ma that such blood tests might develop to become more sensitive to discovering intracranial damage than imaging scans.
At the moment, in elite sports, concussions are diagnosed using the SCAT5 test or Rugby Australia’s Head Injury Assessment (HIA) protocol, both of which identify the concussion based on subjective behavioural symptoms. According to the Centers for Disease Control and Prevention, symptoms of a concussion include confusion, agitation, vomiting, pain or pressure in the head, blurry vision and change in mood, personality or behaviour.
The SCAT5 test in the British Journal of Sports Medicine can be correctly administered by a licensed health care professional in 10 minutes with a time device; the test includes cognitive, neurological and physical screening. The SCAT5 has questions of numeracy, memory recall, reading, head trauma history and evaluation of physical symptoms such as eye response and neck or head pain.
The HIA protocol includes three steps, the first of which is a team or match-day doctor identifying the potential for a concussion in a player through direct observation or video review. If the player displays obvious signs of a concussion, they are immediately and permanently removed from play; if they only have the potential, the player is taken off-site and undergoes a reformatted SCAT5 test. Players with a potential concussion are not permitted to return to play for a 12-minute period in which the SCAT5 test is performed.
Stages two and three of the protocol are follow-ups conducted three hours and two night’s rest after the match’s completion. Stage two is in place to identify an early concussion and consists of the SCAT5 test being administered again. Stage three is established to identify a late concussion and involves a clinical assessment supported by the SCAT5 test and a computer neuro-cognitive tool, which is chosen by the team.
This means that many Australian sporting bodies take an “if in doubt, sit them out” approach to possible concussions, in compliance to Sport Australia guidelines. But, both elite and community games lack a uniform examination process for players after they suffer a possible concussion, and a tool that provides objective and evidenced-based concussion diagnoses would fill this need.
Welcoming the new research project, World Rugby Chief Medical Officer, Dr. Éanna Falvey said that the potential of the study is huge.
“If the leading research from The University of Queensland could discover a blood test which identified concussion in the community game, then it would provide huge benefits not just for rugby but for the whole of world sport.”
“World Rugby has a commitment never to stand still on player welfare,” Falvey said.
“Our six‐point plan to become the most progressive sport in the world in this area includes a commitment to invest in science and research, and this study is just one example of us putting our plan into action.”
In 2021, World Rugby announced a six point plan to advance the sport’s focus on player welfare, with the welfare of former players, women, and the community game at the centre of the initiative.
The plan includes support for former players, head impact prevention with research and technological innovation, welfare-driven law review, dedicated focus on female players, investment in concussion and proper play education programs; and continued engagement and collaboration with the rugby community.
“Our mission is to be the most progressive, open and collaborative sport when it comes to the welfare of our players at all levels,” World Rugby Chief Executive Alan Gilpin said in a news release.
“Rugby is a sport that delivers huge positive health and wellbeing benefits to those who play, and we want many more people to experience it.”
Falvey said that, although the risks associated with youth and community play aren’t comparable to the elite game, this research illustrates rugby’s persistent focus on achieving objective testing to identify and manage brain injuries. She said that rugby is addressing this concern while also modifying laws, tackle techniques and education to advance injury prevention strategies for youth rugby.
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