Optimizing acute mTBI care in the ED: how biomarkers, machine-learning, and psychosocial outcomes can help

Concussion Center faculty council members Dr. Fred Korley and Dr. Katharine Seagly, along with their co-principal investigator, Dr. Chris Fung from Michigan Medicine’s department of emergency medicine, and a team of other collaborators, secured funding support from the Joyce and Don Massey Family Foundation and the Department of Defense for two related projects that will close the current gap in the acute evaluation of mild traumatic brain injury (mTBI). Their work will develop an algorithm for clinical decision-making when managing patients presenting to the emergency department (ED) with a Glasgow Coma Scale (GCS) score of 15 – the mildest form of a traumatic brain injury. 

The current standard of care requires a brain CT for most patients arriving in the ED with a known or suspected head injury. Most patients who present to the ED with a GCS of 15 have a negative head CT, but a small subset is positive for a traumatic intracranial hemorrhage (i.e., bleeding in the brain). Unfortunately, some of these patients,  deteriorate rapidly after the initial scan. The planned algorithm would use blood-based biomarkers and patient histories, such as medical comorbidities and risk factors, to identify this subgroup of patients early to prevent subsequent acute decompensation. 

Once discharged, all patients with initial GCS of 15 and blood-based biomarker data, including those with and without positive head CTs, are receiving follow-up from the study team at 2-week and 3-month time points, where functional, cognitive, psychosocial, and quality of life outcome measures are collected. These data will help determine patterns in who gets better in these domains and who does not. In addition, they will be added to the algorithm to best predict who will most benefit from more comprehensive rehabilitative care early on post-injury and who is likely to get better on their own.

“Our goal is to develop a scientifically informed method for determining who needs which assessments and interventions in order to optimize both acute and long-term outcomes in patients with GCS 15 TBI.” said Dr. Seagly, “By doing so, we can prevent overutilization or underutilization of healthcare resources by sending patients down the right, personalized treatment path as early as possible.” 

Seagly is also the Director of Michigan Medicine’s Brain Injury Rehabilitation Program. One of the program’s focus areas is concussion management through a recovery group. The Concussion Recovery Group, developed by Seagly and led by a licensed clinical social worker, supports all mTBI patients across all injury mechanisms, though it requires a referral. Regardless of how one sustains a concussion, this 6-session group aims to educate patients through evidence-based, patient-centered interventions that can aid recovery and return to usual daily activities. Seagly plans to add a 1.5-hour concussion education session for patients with acute mTBI as an adjunct project for the current mTBI studies in the ED, supporting the patients’ short- and long-term post-discharge outcomes.