Blood protein provides clue for kids’ concussion recovery

A blood protein could help determine whether a child will experience symptoms for more than two weeks after a concussion, offering the possibility to inform acute clinical management responses.
 
While the discovery, led by the Murdoch Children’s Research Institute (MCRI), requires further studies before a blood test would become available to GPs, co-author and MCRI Professor Vicki Anderson said the small study is an important first by identifying the potential marker.
 
‘If the finding holds up in larger studies, the discovery could  … [provide] clinicians with an acute marker to guide more timely and targeted treatments to children most likely to experience long-term problems,’ she said.
 
As part of the research, plasma samples were collected from 80 children who presented to the emergency department at Melbourne’s Royal Children’s Hospital within 48 hours post-concussion.
 
Levels of the protein alpha-1-antichymotrypsin (alpha-1-ACT) were found to be significantly lower in children with a delayed recovery from concussion, suggesting the protein is a potential biomarker for concussion recovery.
 
According to the authors, ‘an accurate prognostic method of this nature has not yet been achieved through the methods of clinic-based assessment and imaging protocols’.
 
However, the research – the first in human trial to identify the protein’s role in concussion recovery – is still in early phases and MCRI researcher and paper co-author, Ella Swaney, said further studies are needed with a larger cohort to validate the findings and make it available in a clinical setting.
 
Ms Swaney said there is an increasing need to develop a tool that can contribute to identifying those at risk of delays to recovery, with concussion a growing public health concern and among the most common of sporting injuries.
 
‘Delayed recovery from concussion spans emotional, behavioural, physical and cognitive symptoms, which can affect the wellbeing of the child, delaying their return to school and sport,’ she said.
 
‘Early detection of children at risk of delayed recovery is crucial to ensure effective treatment and targeted follow-up.’
 
Paediatric concussion is now widely understood to be different to adult concussion in its symptomology and recovery, the paper highlights, with children’s proteome ‘vastly different’ to that of adults.
 
Based on these differences, the research shows that alpha-1-ACT concentration can differentiate between children experiencing delayed and normal recovery from concussion. The protein boasts ‘the potential to transform acute clinical management’ by providing clinicians with a strong predictive marker to guide and target treatments to children most likely to experience delayed recovery.
 
In 2023 a ‘game-changing’ update to the concussion consensus statement was released, providing new best practice guidance on how concussion is viewed across sporting codes, recreational sport, and within medical clinics and emergency departments, by improved exercise and rehabilitation methods and upgrading return-to-school and return-to-sport protocols.
 
Around four million children experience a concussion each year, the authors note, of whom 25–30% will have long-term symptoms, and around 50% will never seek medical care.
 
The key to optimum patient outcomes in paediatric concussion is early and accurate diagnosis, effective treatment, and safe return to exercise, learning, and sports and leisure, they state.
 
And while a simple blood test to detect concussion recovery time is yet to become available, one mother of a teenager who suffered a bad concussion on the netball court said the MCRI research offers some ‘welcome relief’.
 
‘If clinicians can easily find out which children will have long-term concussion symptoms, then they can receive targeted and early intervention,’ she said.
 
‘Recovery from concussion can be a long process, like our daughter’s, and anything that can help speed up the process would make a world of difference.’
 
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