New frontier for concussion testing as rugby players put to the test

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A prototype of the hand-held device being developed by the University of Birmingham to test for concussion
A prototype of the hand-held device being developed by the University of Birmingham to test for concussion.

A major study is being undertaken in Britain to develop a ground-breaking sideline test to diagnose concussion and brain injury in sports people.

Rugby players from Aviva Premiership Rugby and Greene King IPA Championship are to take part in the study led by the University of Birmingham.

It will run throughout the 2017/18 rugby season and is the biggest of its kind to take place in the history of UK sport. It is a key element in the University of Birmingham’s research programme to create a test that can be performed rapidly pitch-side and will determine whether a player has been concussed. The study is part of the University of Birmingham’s REpetitive COncussion in Sport (RECOS) project.

The test also has the potential to assist in return to play decisions and could be used across sports, from grassroots to professional level. It is hoped it could also be used more widely by frontline medics in the NHS and military to improve diagnosis and treatment within the first critical hour after brain trauma.

The team at the University’s College of Medical and Dental Sciences, led by neurosurgeon Professor Tony Belli, has spent the last nine years carrying out research which has led to the development of a test that measures biomarkers present in the saliva and urine of players. The test, if validated, could be done on a hand-held device, which is currently under development.

University of Birmingham Professor Tony Belli with the prototype of the hand-held device to test for concussion.
University of Birmingham Professor Tony Belli with the prototype of the hand-held device to test for concussion.

Professor Belli said: “Early and accurate diagnosis of concussion is one of the biggest challenges we face clinically and is particularly a major concern in the sporting world.

“The University of Birmingham recently made a significant breakthrough after identifying molecules, which can be found in saliva and act as biomarkers to indicate whether the brain has suffered injury.

“In this exciting next study with the RFU, Premiership Rugby, and the Rugby Players’ Association we will collect players’ saliva and urine pre and post-injury, which we will then test in the laboratory in order to assess the reliability of these biomarkers.

“If these biomarkers are found reliable, we can continue our work with industrial partners with the hope to have a device available within the next two years that will instantaneously diagnose concussion on the pitch-side with the same accuracy as in the laboratory – a major step forward for both sport and medicine.”

 

 

Players participating in the study will provide saliva and urine samples to act as a base-line benchmark. During a match, players with confirmed or suspected concussion will provide saliva samples immediately following injury. Players will also provide follow-up saliva samples, as well as urine samples, as they go through the return to play protocol. These will be compared to the baseline benchmarks, plus those from players from the same game who did not suffer head injury, and those who had other injuries. If there are no Head Injury Assessments (HIAs) or confirmed concussions in a match, then no samples will be collected.

Rugby Football Union Chief Medical Officer Dr Simon Kemp, left, and University of Birmingham's Professor Tony Belli.
Rugby Football Union Chief Medical Officer Dr Simon Kemp, left, and University of Birmingham’s Professor Tony Belli.

The study will be carried out during all Aviva Premiership and Greene King IPA Championship club competitions where the HIA is in operation and will run alongside the existing HIA off field screen that will be for a fixed period of ten minutes. This study replaces the King-Devick research project that was conducted last season. The King-Devick results are currently being analysed and the aim is to publish the findings following scientific peer review.

The latest study is being funded by the British Medical Association, National Institute for Health Research, the Ministry of Defence, the Medical Research Council and the Rugby Football Union.

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