Optimizing Concussion Care Seeking: Connecting Care-Seeking Behaviors and Neurophysiological States Through Blood Biomarkers.

BACKGROUND

Timely and appropriate medical care after concussion presents a difficult public health problem. Concussion identification and treatment rely heavily on self-report, but more than half of concussions go unreported or are reported after a delay. If incomplete self-report increases exposure to harm, blood biomarkers may objectively indicate this neurobiological dysfunction.

PURPOSE/HYPOTHESIS

The purpose of this study was to compare postconcussion biomarker levels between individuals with different previous concussion diagnosis statuses and care-seeking statuses. It was hypothesized that individuals with undiagnosed concussions and poorer care seeking would show altered biomarker profiles.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Blood samples were collected from 287 military academy cadets and collegiate athletes diagnosed with concussion in the Advanced Research Core of the Concussion Assessment, Research and Education Consortium. The authors extracted each participant's self-reported previous concussion diagnosis status (no history, all diagnosed, ≥1 undiagnosed) and whether they had delayed or immediate symptom onset, symptom reporting, and removal from activity after the incident concussion. The authors compared the following blood biomarkers associated with neural injury between previous concussion diagnosis status groups and care-seeking groups: glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and tau protein, captured at baseline, 24 to 48 hours, asymptomatic, and 7 days after unrestricted return to activity using tests of parallel profiles.

RESULTS

The undiagnosed previous concussion group (n = 21) had higher levels of NF-L at 24- to 48-hour and asymptomatic time points relative to all diagnosed (n = 72) or no previous concussion (n = 194) groups. For those with delayed removal from activity (n = 127), UCH-L1 was lower at 7 days after return to activity than that for athletes immediately removed from activity (n = 131). No other biomarker differences were observed.

CONCLUSION

Individuals with previous undiagnosed concussions or delayed removal from activity showed some different biomarker levels after concussion and after clinical recovery, despite a lack of baseline differences. This may indicate that poorer care seeking can create neurobiological differences in the concussed brain.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: All authors received funding from the National Collegiate Athletic Association (NCAA) and/or the Department of Defense (DOD) to complete this investigation and cover travel costs related to the study. This work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the DOD through the Psychological Health and Traumatic Brain Injury Research Program under award No. W81XWH-20-2-0044. This publication was also made possible with support from the Grand Alliance Concussion Assessment, Research and Education (CARE) Consortium, funded in part by the NCAA and the DOD. The U.S. Army Medical Research Acquisition Activity (820 Chandler Street, Fort Detrick, MD 21702-5014) is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under award No. W81XWH-14-2-0151. J.R.M. and R.C.L. have received research funding from the National Operating Committee for the Standards on Athletic Equipment. S.P.B. has consulted for US Soccer (paid), US Cycling (unpaid), and medicolegal litigation; and received speaker honoraria and travel reimbursements for talks given. He is coauthor of