India has the highest rate of head injury in the world. In India, over 100,000 lives are lost every year with over one million people suffering serious head injuries. One in six individuals in India who suffer brain trauma die. This is a startling figure compared to the figure of one out of every 200 who die as a result of brain trauma in the United States.
One explanation for this is hat an estimated 95 percent of trauma victims in India do not receive optimal care during the “golden hour” period after an injury is sustained. In many cases this is due to a lack of available healthcare facilities.
Many rural healthcare centres in India are poorly equipped, with some being inadequately prepared for even the most basic of procedures. With access to quality healthcare and services in these areas being so uneven, emerging technologies that simplify procedures could be vital to identifying brain trauma as swiftly as possible. This would, at the very least, help in identifying those who desperately need treatment as quickly as possible.
Access to more complex procedures such as a CT scan may be all but impossible for many in geographically isolated rural areas, necessitating a trip to the nearest city hospital, or simply not going through with the procedure at all. This can delay the administering of what could be lifesaving medical attention.
New research suggests a simple blood test may be able to partially replace the need for CT scans in the case of head trauma. First reported in The Lancet the proposed blood test would allow doctors to check for traumatic intracranial injuries like brain haemorrhage and contusion before resorting to CT scanning.
Currently, procedures to identify traumatic brain injury (TBI) involves a series of checklists of symptoms and signs. A doctor will perform assessments to test the patient’s initial level of alertness — usually measured using the Glasgow Coma Scale score (GCS). Scores below fifteen on this scale warrant a CT scan.
However, the severity of the case on this scale is defined by the physician identifying the case. Due to this there can be factors that may interfere with the investigation. For example, if the patients has fallen under the influence of alcohol and suffered an impact to the head. In this case an assessment based on alertness could be flawed as it will be unclear whether the lack of awareness is due to TBI or intoxication.
The new blood test provides a far more accurate means to identify whether the brain has sustained trauma. The blood test involves an analysis for two proteins within the blood; ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP). Both of these proteins have been shown to have a high concentration within the blood following brain trauma.
High levels of these proteins within the blood was shown to not only correlate with the presence of TBI. Increased elevation over a period of days after the causative injury was found to be correlated with the risk of mortality from the resultant TBI.
The Lancet study compared the tests for these two proteins with CT scan results. The findings of the study indicated that the blood test for these proteins accurately predicted the incidence of TBI in 99.6 percent of patients tested.
Blood tests are far faster and considerably more accessible than CT scans. With this in mind, the implications of the study for India – and, indeed, for the rest of the world – is that through faster identification of TBI, more appropriate and swifter responses can be made in terms of treatment, with the potential to save a considerable number of lives.
The most common risk group are young men, potentially implying a link between TBI and manual labour. This possibility is backed up by the most common cause of TBI, which is a knock to the head following a fall from height.
Falling comprised 56 percent of all TBI cases in India, with road accidents coming second with 36 percent of all cases. Together, these two incidents comprise nearly all of the TBI cases in India, at a total of 92 percent. If this standardised blood test was made mandatory in the case of these two events, brain trauma would be picked up at a far higher rate, giving a much higher chance of successful treatment, leading to more lives saved.