For healthcare professionals

While progress has been made in characterizing factors that influence the risk of experiencing prolonged effects of a concussion, no review to date has consolidated the literature that explores how genetic variations contribute to the risk of persistent impairment and the range of symptoms following concussion. This review provides a synopsis of published primary research findings on genetic variants which modify the risk of adverse sequelae following concussion. Prospective, cross-sectional, and case-control studies that examined genetic variants in relation to persistent impairment following concussion (>30 days from injury) were included in the review. The findings suggest that genetic variation plays a role in modulating the duration and severity of post-mTBI symptomatology; however, the influence of other variants on mTBI outcomes remains less clear.

A growing body of research has identified that outcomes associated with TBI may differ depending on how the TBI was sustained. In this study, researchers examined whether concussion mechanism of injury (high-level blast [HLB] vs impact) affects the likelihood of persistent sleep problems in members of the military after deployment. Findings suggest that those with HLB-induced concussions are more likely to report persistent sleep problems than those with impact-induced concussions, particularly in the presence of PTSD and/or depression. These findings underscore the need to monitor and treat sleep issues during TBI recovery. Medical providers may consider additional follow up for those with HLB-induced concussions and comorbid PTSD or depression to ensure adequate treatment for sleep issues as a pathway to promote recovery and overall well-being.

Lingering and difficult-to-detect post-concussion sensorimotor impairments may contribute to an increased likelihood of subsequent musculoskeletal injury in the year after concussion for some adolescent athletes, particularly in the immediate months following return to sport. Currently, clinicians are unable to identify who is at higher risk of subsequent musculoskeletal injury following concussion. In this study, researchers sought to test for the first evidence of suppressed general startle reactivity in adolescent athletes with a recent concussion compared to those without a concussion history. Results suggest that general startle reactivity is a potential biomarker for concussion and may provide additional insight into the mechanisms of concussion and increased incidence of subsequent injuries.

Growing evidence suggests that peripheral biomarkers of inflammation, such as interleukin (IL)-6 and 1IL-1 receptor antagonist (IL-1RA), are elevated acutely following concussion and potentially associated with slower recovery. The objective of this study was to determine the association of markers of inflammation with clinical symptoms and recovery following acute concussion in collegiate athletes and military service academy cadets. The researchers found that the association of symptoms and inflammatory markers was only significant at the 12- to 36-hour post-injury window. This study highlights that peripheral inflammation is associated with psychological symptoms observed post-injury, which have implications for observed clinical recovery and return to activity after concussion. Current results do not provide strong support for a potential prognostic role for these markers.

This study compared serum glial fibrillary acidic protein (GFAP) and neuronal ubiquitin C-terminal hydrolase (UCH-L1) biomarkers to validated clinical decision rules for detecting intracranial lesions on head CT scans in mild traumatic brain injury patients. In a cohort of 349 patients, the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), and GFAP plus UCH-L1 all had 100% sensitivity for detecting lesions. The CCHR had the highest specificity (33%). Combining GFAP levels with the CCHR yielded the best diagnostic performance. These results suggest that combining biomarkers with clinical decision rules improves diagnostic accuracy in detecting intracranial lesions on CT scans. 

The study evaluated plasma biomarkers—ubiquitin C-terminal hydrolase-L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and S100 calcium-binding protein B (S100B)—in patients with acute traumatic brain injury (TBI). A cohort of 109 adult TBI patients was recruited within 6 hours of injury. In a hyperacute subcohort (20 patients), GFAP and UCH-L1 levels were significantly higher in CT-positive patients. Combining GFAP and UCH-L1 improved diagnostic accuracy for intracranial lesions. These findings highlight their clinical utility in TBI assessment.