Concussion prevention and detection products

Thankfully, scientists are constantly inventing and studying products to help detect and prevent concussions.  We wanted to take a moment to summarize what we have learned about those products most recently introduced.  Though research is ongoing, and time will tell how well these products work and can be utilized in real-time, it is exciting to consider these new tools. 

Concussion prevention: Q-Collar

1. What is it? A compression collar worn “around the neck by athletes aged 13 years and older during sports activities.”
2. What does it claim to do? It claims to help prevent concussions in contact sports.  How can it do this, you ask?  It applies "light pressure to the jugular veins, which slightly increases blood volume inside the head and helps reduce the brain’s movement."  The brain movement after a hard hit they refer to as “brain slosh.”  By reducing the brain’s movement in the skull we can minimize concussions.  Helmets do not help with preventing “brain slosh,” but instead help prevent skull fractures.  Though of course helmets are extremely useful, they can still allow “rapid acceleration and deceleration movement of the brain inside the head that leads to the twisting and tearing of neurons, which is the cause of traumatic brain injury (TBI),” aka concussion.  The Q-Collar claims to help prevent this from occurring.   
3. What do we think about it? Time will tell; however, it sounds like a great product with a large amount of good research behind it.   Data consistently shows significantly less changes in brain white matter (the deeper part of the brain, composed of nerve cells) for those wearing the Q Collar after a season of contact sports play.  This is very encouraging.  Lastly, the price of $199 seems well worth the it if it can perform as advertised.

Concussion detection: Abbott's i-STAT™ Alinity blood test

1. What is it? A blood test to diagnose concussion.  There are a couple different options out there; the one which we have reviewed is Abbott's i-STAT™ Alinity. 
2. What does it claim to do?  Similar to blood testing after a heart attack revealing certain blood levels indicating damage to the heart muscle, researchers think that certain blood biomarkers could also be used to indicate brain injury.   This has been much researched in the past 20 years leading to the FDA approving Abbott's i-STAT™ Alinity to measure the biomarkers UCH-L1 and GFAP in January of 2021.  These biomarkers measure “brain-derived proteins” that can be detected in the bloodstream “within minutes to hours” of a concussion. 
3. What do we think about it? Good question!  We have not yet heard of this tool being utilized in daily life, so we don’t yet have any real life experience with this yet.  That being said, for our office specifically, we don’t expect this test to be very useful.  These biomarkers appear in the blood within minutes to hours after a concussion. Because we don’t typically see patients until 2-3 days post-injury or later, this testing would likely not be helpful to us.  Additionally, we can diagnose a concussion based on the symptoms that the patient reported after his/her head injury, so having a blood test to confirm concussion won’t prove very useful for our office.  After diagnosing a concussion based on initial symptoms, we determine severity of concussion based on how long symptoms last, physical examination findings, and cognitive testing results.   (In case you are wondering how we can diagnose a concussion solely based on symptoms, it’s actually really easy! If your child/teen has a head injury and his/her ONLY symptom is soreness to the head at the site of the hit, it is likely not a concussion – though this can still warrant evaluation by your primary care provider.  However, if there is a hit to the head that causes ANY of these symptoms, immediately or even days after a head injury, it is likely a concussion and needs evaluation:  feeling dazed or stunned, getting your “bell rung,” headache that worsens with thinking or movement, dizziness, impaired balance, impaired memory or concentration, fogginess, blurry vision, light or noise sensitivity, nausea or vomiting, sleep disturbances, and changes in mood.)   

          Though blood brain biomarker testing will likely not be helpful for the    outpatient pediatric office, it could have use in an ER setting.   When a patient is referred to the ER, it is likely because their injury is severe enough to consider a CT scan to rule out a bleed in the brain. (CT scans can’t determine a concussion since a concussion is an injury to the cells in the brain which can’t be seen on imaging, but it can detect something more severe, such as bleeding in the brain, which can be associated with a more severe concussion).  Those athletes who need further evaluation, and potentially a CT scan to rule out bleeding in the brain, present with more significant post- concussion symptoms such as loss of consciousness for 30 seconds or more, 1 sided neurologic finding (including unequal pupils), repeated vomiting, or progressively worsening and worsening headache.  In patients with these more significant symptoms, perhaps this test or one like it could potentially help determine who needs and who does not need a CT scan, and protect those who do not need it, from CT scan radiation.

In summary, we are thankful for the constant research being done to invent and study products to help detect and prevent concussions.  As we hear of new products coming to the market, we will do our best to review the literature and see what may help us as we care for our patients.  It is exciting to consider these new tools. 

References:

1. https://qcollar.com/pages/fda-reviewed
2. https://abbott.mediaroom.com/2021-01-11-Abbott-Receives-FDA-510-k-Clearance-for-the-First-Rapid-Handheld-Blood-Test-for-Concussions#:~:text=TBIs%2C%20including%20concussions%2C%20are%20an,tool%20used%20to%20diagnose%20concussion.
3. https://www.aacc.org/cln/articles/2020/september/concussion-biomarkers-where-they-stand-now