Mild head injuries can be just that — mild. On the other hand, a blow to the head can cause serious problems and remain a threat to health after the brain injury appears to have been resolved.

New research published in JAMA Neurology will help to determine how serious an injury to the head may be. Having more tools to better understand the damage to the brain will further the development of acute treatments and long-term interventions to prevent the negative sequelae that can accompany brain injury.

Linda Papa, M.D., of the Department of Emergency Medicine at Orlando Regional Medical Center, led a team that evaluated two biomarkers for brain injury: glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1). They did a prospective cohort study that enrolled 1,030 adult patients over a period of four years to evaluate the blood profiles of the biomarkers GFAP and UCH-Li.

The data of each biomarker was evaluated individually and in combination to determine how accurate over a period of time either were in detecting mild to moderate traumatic brain injury (TBI), as demonstrated by traumatic intracranial lesions detected by computed tomography or actual neurosurgical procedures.

A total of 584 of the initially enrolled patients had a series of 19 blood samples over 180 hours. They found that GFAP was a good biomarker for mild to moderate TBI over the entire period evaluated. UCH-L1 did identify the injury, but had its accuracy in the early post-injury stages.

With an estimated 5-10 percent of athletes experiencing a head injury during a sport season, better and more efficient diagnostic tools are important to help providers and parents better manage the activities of children and teenagers.

The Centers for Disease Control and Prevention (CDC) reports the rate for TBI-related emergency department visits has increased in recent years. The rate for the year 2010 was 823.7 events per 100,000, compared to 521.0 in 2001.

Having biomarkers is critical for injuries that occur in remote regions or in the field. The Department of Defense reports that between 2000 and 2015 there were 339,462 military force members diagnosed with a TBI, with 279,898 being classified as mild. However, there is no accurate means to determine how many blast injuries went undiagnosed. A readily obtained blood test may be an effective means to better manage injury in the field.

The biomarker under study by Papa is not the only one. Another medical group followed 12 professional hockey teams from Sweden. They measured baseline blood biomarkers at the onset of the season, then subsequently measured the biomarker at the time of a TBI.

They identified 35 players with injury, and 28 of these had a series of specimens taken over a time period of 144 hours. Researchers measured the total tau and S-100 calcium-binding protein B immediately after a concussion, and both decreased during rehabilitation.

They concluded the concussions in professional hockey players has an association with acute axonal and astroglial injury, and the biomarkers are indicative of injury.