Kuehl: Better Tools for Healing: A Clinical Trial Looks at Traumatic Brain Injuries
Damon Kuehl, M.D., is vice chair of Emergency Medicine at Carilion Clinic.
For sports lovers, pausing athletic competition during the COVID-19 pandemic has been as unwelcome as the coronavirus itself. Professional and college sports found ways to operate in bubbles – but without fans! And the days of youngsters in gyms, arenas and fields playing the sports they love in front of friends and family? Mostly memories for the last year.
We're continuing to put the pandemic behind us by being cautious (wear masks!) and getting vaccinated. And we’re starting to see sports again at all levels, including in our schools and communities. Carilion athletic trainers are working again with young athletes on nutrition, stamina, and preventing injuries. Of course, they’re also on the sidelines to help players when they are injured.
Sports and outdoor activities are kicking into gear in our region just as we close out Brain Injury Awareness Month. Meantime, we’re keeping our focus on one of the most common sports-related injuries – concussions.
First, let’s start calling them what they are: brain injuries. Concussions are mild traumatic brain injuries or mTBI for short. As an emergency medicine physician at Carilion Roanoke Memorial Hospital, I see many patients with head trauma. Many of those patients sustain an mTBI, but sometimes making the diagnosis is a best guess, as in: “The CT scan was normal. Let’s wait and see?”
It’s estimated 3.8 million mTBIs occur in the United States each year during recreation and sports. However, that’s just a best guess, too. Many aren’t reported, and rapid and accurate tests to diagnose them don’t exist. That’s why I’m excited about a promising collaborative study of a new diagnostic tool that may help us identify mTBIs not just in the ED but right on the sidelines.
Diagnosing an mTBI remains elusive. It’s true, many patients with the condition will heal quickly, but some do not. A significant number go beyond the “brain fog” associated with a hit to one’s head and develop prolonged and disabling physical and emotional symptoms. We especially need to quickly find those at-risk for more serious effects from their brain injury to develop better treatments and ultimately improve outcomes.
My colleagues across various disciplines and several organizations have sought ways to improve how we diagnose and treat suspected and known mTBI patients. During the formation of the Virginia Tech Carilion partnership over a decade ago, one of our goals was to find ways for scientists and clinicians to collaborate on research to improve our communities (and well beyond) using the so-called bench-to-bedside connection.
Among our success stories is our collaboration with a biotechnology start-up company, BRAINBox Solutions, the sponsor of the clinical trial we began this month for those with an mTBI.
Three years ago, the Fralin Biomedical Research Institute at VTC secured a grant to begin working with BRAINBox to accelerate developing a system to diagnose and manage mTBIs. BRAINBox’s work widens the understanding of a brain injury’s biological and functional impacts – right in our region.
The company’s federally approved "Breakthrough Device" is a lab test the size of a USB drive paired with a smartphone or tablet. It rapidly measures molecules in patient blood samples, identifying many different proteins that form after brain cells are injured. The lab results plus cognitive, balance, coordination, and eye movement assessments combine to complete the test.
One of BRAINBox’s goals is to go beyond diagnosing an mTBI and provide a prognosis. We want to predict short- and long-term outcomes, including identifying those at risk early for prolonged or severe effects from their mTBI.
Our clinical trial is critical to finding solutions for quickly diagnosing mTBIs and developing programs of care for patients throughout the country and around the world. The trial will be conducted across the U.S., England and New Zealand.
Our great hope is this study will stop the guessing. The treatment of mTBIs and the concerning effects of repeat concussions hinges on diagnosing each of them accurately. We’ll also look at how concussions impact the physical and emotional well-being of our patients. And hopefully, we’ll help them return to lives well-lived – and maybe even back to the field or rink they had to leave due to their injuries.
We're all anxious to be back among the crowds of spectators who help fuel athletes at all levels, including the young ice hockey players I enjoy coaching. With more precise diagnosis and treatment, athletes and others sidelined due to mTBIs will benefit from the kind of change we're longing for in our post-pandemic world.