This brief story discusses a new study published in JAMA Neurology about blood tests for two biomarkers that may assist in the diagnosis of traumatic brain injuries among patients brought to a level-one trauma unit. The story was careful not to exaggerate the potential of the blood markers in assessing the severity of concussions. (Note: See our separate review of the news release here: Another ‘simple blood test’ for concussion PR release over-promises)
However, it missed the mark in some important ways: It didn’t tell us how these biomarkers fared on accuracy, and it lacked independent sources, such as a brain injury or concussion expert who wasn’t connected to the research.
We saw some of the same limitations in another story we reviewed about the use of flashcards in detecting brain injury.
If a simple blood test can accurately predict traumatic brain injury, then patients may be spared the effects of radiation from a diagnostic CT scan, and clinicians– including ambulance and emergency room attendants–might have a more rapid and affordable diagnostic tool in assessing patients. However, a lot more research is needed to know if this is the case. These individuals had enough of an injury to be treated at a level one trauma center. As such, the study may not be able to answer whether the test can be used in the majority of cases, which involve milder injuries. And these results were only applicable to adults, even though the story references drawbacks of CT scans for kids, implying these blood tests could be used for children, too.
Costs are not addressed here. But readers should be informed if there are commercially available tests for the proteins the researchers were measuring, and how much they cost. If not, the costs of tests for similar proteins could possibly be used to give a ballpark estimate.
Readers should be informed of how many people with a concussion were accurately identified, and how many people without concussions were accurately ruled out. The story doesn’t tell us, nor any other quantified benefits.
The story doesn’t mention any harms, but all screening tests have harms associated with false positive and negative results. In athletes, for example, a false positive test keeps you off the field and creates unnecessary anxiety. A false negative result means you go back on the field with a concussion and potentially suffer another head injury that could have catastrophic consequences.
This was a tough call, but we’re going with Satisfactory because the story included descriptions of the study’s design, such as the sample size and the fact that patients without head injuries were included as a control comparison, which to some degree gives readers a sense of the quality of the study.
However, the story otherwise had barebones information. What were the benefits and drawbacks to a study like this? For example, the study looked at adults, not children. The commentary of an outside observer could have given readers more context.
No obvious disease mongering in this story. Concussions and traumatic brain injury are a serious public health issue.
This story included no independent sources, and failed to mention a potential conflict of interest with the only source quoted in the story. As stated in the JAMA Neurology study, lead researcher Dr. Linda Papa was listed as one of several researchers who have consulted or received contract research funding from Banyan Biomarkers, Inc. Banyan is a for-profit biotech company in Florida seeking to commercialize a biomarker for head injury.
The story mentions CT scans as the current primary tool for hospital-based diagnosis, so we’ll count this as Satisfactory.
However, given that the story does talk about these blood tests possibly being used by athletic trainers, we’d have liked to have seen a brief comparison of what’s currently used in sports settings, such as the Standardized Assessment of Concussion, which measures cognition and a timed tandem gait test of balance.
The story implies these tests aren’t yet available, chiefly by calling them “promising.” However, the story should have made it explicitly clear whether these tests are something patients could ask for now.
The story establishes the novelty of this study’s premise by letting us know “the research team focused on two blood proteins that have already been linked to brain injury.”
The story includes quotes from the lead researcher that did not appear in the news release, so we’ll count this as Satisfactory.
Systematic, Criteria-Driven
Today, when nobody bats an eye at rampant cronyism and COI in health care, is precisely when we need Gary to be shining a light on these issues in health care journalism. https://twitter.com/garyschwitzer/status/1290973141758611459
There’s no one I trust more than @garyschwitzer for critical evaluations of what the health-science media is doing (and not) around #COVID19. Here he takes a hard look at narratives around vaccines. You should read. https://twitter.com/garyschwitzer/status/1288827619908214784
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