Researchers from the University of Cambridge are proposing a project on head injury. They need your views! Leave your comments below.
Aims of the research
Our research aims to improve the management of patients presenting to the emergency department with a mild head injury, by using a blood test for markers of brain injury. Specifically, I wish to determine whether markers identified from a blood sample are able to:
Refine decision-making on need for computerised tomography (CT) scans.
Better identify the patients with normal CT scans in whom magnetic resonance (MR) scans may show abnormalities.
Identify - either alone or in combination with MR scans - patients at risk of persistent symptoms.
Quantify the improvements that such blood tests provide in identifying the need for CT scans, MR scans and follow up.
Quantify any savings in efficiency and/or costs to the NHS delivered by these improvements.
Background to the research
Nearly 1 million people present to UK emergency departments with a mild head injury every year, of which ~1% will have suffered life-threatening bleeding in the brain that requires neurosurgery. Such bleeding, and other injuries including skull fractures can be detected on a CT scan, which uses radiation. The National Institute for Health and Care Excellence (NICE) published guidelines for clinicians to select patients for CT scanning. However, NICE recognises the limitations of the current guidelines and recommends research into blood tests for markers of brain injury to reduce the use of CT.
Approximately 15-30% of patients with a mild head injury will develop post-concussion syndrome (PCS), a collection of disabling symptoms ranging from headaches, to memory problems and depression. These can persist for months to years. Early treatments have been hindered by our inability to predict which patients will develop PCS. However, blood tests and advanced magnetic resonance (MR) scans have recently shown promising results in identifying patients at risk. Better clinical decision tools are needed to select patients for CT scans, MR scans and PCS follow up in order to reduce radiation burden, cost and disability.
Design and methods used
We will analyse data from two large studies (CENTER-TBI and TRACK-TBI) that enrolled more than 4000 patients with seemingly mild head injuries. We have very detailed information about each patient including their symptoms, blood tests and scan results and their recovery over two years. We will study how blood tests for brain injury are linked to CT results and concussion in the CENTER-TBI patients. We will then test if we find the same link in the TRACK-TBI patients. We will look for these links with traditional statistical methods and modern artificial intelligence techniques.
Once we identified the links, we will work with lay members and clinicians to build clinical decision aids that can be used in the emergency department.Finally, we will do a costing study to compare these blood tests with current NICE guidelines. This will show whether using blood tests for brain injury would be value for money in the NHS.
Patient and public involvement
Patients and the public were involved in the planning of the project. We will collaborate with a patient-and-public advisory group when building the decision making tool, to ensure the risks and benefits of management strategies are acceptable to the general population.
We aim to develop a decision tool for the management of patients with mild headinjuries, to reduce radiation burden, cost and disability. Such a tool could also identify patients for trials of early treatments for PCS. Results will be published in scientific journals and disseminated to the public through engagement events, social media and a project-specific website. It is anticipated that results will inform the next edition of the NICE head injury guidelines.
Biomarkers to Optimise Patient Pathways in
Mild Traumatic Brain Injury (BiOPPtic – mTBI)
If the test identified you as being at risk of ongoing symptoms, would you like to receive further follow-up or maybe even participate in a clinical trial for early treatments/preventions?
If you ever had a head injury: Were you satisfied with the information you received about your chances of recovery, or did you feel better predictions are needed?
Would you like to change anything about the project?
If there was a blood test to identify your risk of ongoing symptoms after a head injury, would you be willing to have it done?