Navy Capt. Michael Wagner, the Traumatic Brain Injury director at a military base in Kandahar, Afghanistan, wraps up his examination of a soldier who was exposed to a bomb blast during combat operations. Although medical personnel currently lack a foolproof method of diagnosing concussions, the Army has been working on developing a blood test that can accurately detect them.
"This is huge," said Gen. Peter Chiarelli, the Army vice chief of staff.
Army Col. Dallas Hack, who has oversight of the research, says recent data show the blood test, which looks for unique proteins that spill into the blood stream from damaged brain cells, accurately diagnosing mild traumatic brain injury in 34 patients.
Doctors can miss these injuries because the damage does not show up on imaging scans, and symptoms such as headaches or dizziness are ignored or downplayed by the victims.
If the brain is not allowed time to recover and a second concussion occurs, permanent damage may result. Brain injuries afflict 1.4 million Americans each year, says the National Brain Injury Association. Seventy percent are mild cases.
About 300,000 troops in Iraq and Afghanistan have suffered concussions, mostly from roadside bombs, according to a RAND Corp. study.
Hack says the new findings could rival the discovery of unique proteins in the 1970s that now help doctors identify heart disease.
"This will in fact do for brain injury what that test did for chest pain. It's going to change medicine entirely," Hack says.
If the Army wins FDA approval for the test, the discovery could be a milestone in brain-injury care, says Gregory O'Shanick, national medical director for the Brain Injury Association of America.
"We will find people who are under the radar and then treat them appropriately," he says.
The Army collaborated on the biomarker program with Florida-based Banyan Biomarkers, company created by former faculty member of the University of Florida.
The company recently received $26 million to conduct a final, large set of clinical trials through 2013 on 1,200 patients suffering mild to moderate to severe brain injuries. The patients will be drawn from 30 trauma centers across the country. The success of this phase will determine FDA approval for public use of the biomarker test, Hack says.
"We're trying to see if we can make that (clinical trial) earlier and make it faster," Hack says.
Physician Jeffrey Bazarian said the results may be flawed if researchers are studying only people admitted into hospitals. Their brain injuries, even if characterized as mild, may be more severe than common forms of concussion.
"The key is whatever patients they study need to look like concussed patients, walking, talking and not necessarily in need of hospitalization," said Bazarian, a trauma specialist who has served on task forces involving brain injury and panels for the Centers for Disease Control and Prevention. "If you just look at the milds that are admitted ... that's potentially a flaw."