The Journal of Neurotrauma - 1

EXPERT PANEL DISCUSSION

Advances in the Rapid Detection
of Traumatic Brain Injury
Moderator: Donald W. Marion, MD, MSc1
Participants: Jeffrey J. Bazarian, MD, MPH,2 Jessica Gill, RN, FAAN, PhD,3
Geoffrey Manley, MD, PhD,4 Michael A. McCrea, PhD, ABPP,5 and Ava M. Puccio, RN, PhD6
1

Neurosurgery Consultant, General Dynamics Information Technology in support of The Defense and Veterans
Brain Injury Center, The Defense Health Agency, Silver Spring, Maryland, USA.
2
Professor of Emergency Medicine and Neurology, University of Rochester School of Medicine, Rochester,
New York, USA.
3
Acting Scientific Director, National Institute of Nursing Research (NINR), National Institutes of Health; Deputy
Director, Center for Neuroscience and Regenerative Medicine (CNRM), Bethesda, Maryland, USA.
4
Margaret Liu Endowed Professor in Traumatic Brain Injury, Weill Institute for Neurosciences, Professor
and Vice Chairman of Neurological Surgery, Co-Director, Brain and Spinal Injury Center, University of
California, San Francisco, Chief of Neurosurgery, Zuckerberg San Francisco General Hospital and Trauma
Center, San Francisco, California, USA.
5
Professor and Vice Chair of Research, Co-Director, Center for Neurotrauma Research (CNTR), Department
of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
6
Assistant Professor of Neurological Surgery, Co-Director Neurotrauma Clinical Trials Center, University of
Pittsburgh, Department of Neurological Surgery Pittsburgh, Pennsylvania, USA.

Five national experts discuss the clinical care of patients with concussion and biomarkers of concussion
to determine why biomarkers are important, which
ones are the most promising candidates for evaluating
concussed patients, and the need for point of care
testing. While it is recognized that there are several
different kinds of biomarkers available, the focus for
this discussion is on blood biomarkers.
Dr. Marion: I have been at the Defense and Veterans Brain Injury Center for about ten years. When
I started, one of the first questions I asked the director of the Center (at that time Colonel Michael
Jaffee) was what he viewed as the single most
critical problem in the Military related to traumatic brain injury. He said it was not severe traumatic brain injury, which had been my focus for
much of my career before then, but rather it was
mild traumatic brain injury, also known as concussion. Then, as well as now, concussions accounted for 80% to 85% of the traumatic brain
injuries diagnosed in the active duty Military. Coª 2020 by MARY ANN LIEBERT, INC.

lonel Jaffee was concerned that we did not have an
objective marker for concussion. The diagnosis of
concussion was based on the patient's self-report,
but this was a problem because the ethos among
Service Members was to get back to the fight as
soon as possible, so the Service Member often
withheld information that might keep them out of
the fight.
But research from the team at the University of
California, Los Angeles and others had provided
compelling evidence that if you go back to the fight
too soon and sustain a second TBI before fully recovering from the first, you will likely have a more
prolonged recovery, with the possibility of experiencing second-impact syndrome or permanent
neurologic injury.1
The concerns are similar in the sports medicine
world, so it is very important that we have tools that
will allow us to confirm the diagnosis of concussion
with as much certainty as possible before we sign
off on letting patients get back to duty or return to
sport. It is timely that a number of organizations
1

The Journal of Neurotrauma

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