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

Author:

D’Lauro Christopher12ORCID,Register-Mihalik Johna K.32,Meier Timothy B.42,Kerr Zachary Yukio32ORCID,Knight Kristen52,Broglio Steven P.62,Leeds Daniel72,Lynall Robert C.82ORCID,Kroshus Emily92,McCrea Michael A.42,McAllister Thomas W.102,Schmidt Julianne D.82ORCID, ,Master Christina112,McGinty Gerald122,Jackson Jonathan C.122,Cameron Kenneth L.132,Buckley Thomas142,Kaminski Thomas142,Mihalik Jason P.152

Affiliation:

1. Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA

2. Investigation performed at University of Georgia, Athens, Georgia, USA

3. Matthew Gfeller Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

4. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

5. Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA

6. University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA

7. Computer and Information Sciences, Fordham University, New York, New York, USA

8. UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA

9. University of Washington, Department of Pediatrics & Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Seattle, Washington, USA

10. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA

11. Division of Orthopedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

12. United States Air Force Academy, Colorado Springs, Colorado, USA

13. Keller Army Hospital, United States Military Academy, West Point, New York, USA

14. Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA

15. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Abstract

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.

Funder

U.S. Department of Defense

Publisher

SAGE Publications

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