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Description

Purpose: Mild traumatic brain injury (mTBI) affects 69 million people annually worldwide. A significant subset of those affected will develop long-term sequelae that can seriously impact quality of life and lead to other health problems. Clinical diagnosis of mTBI is complicated by patient malingering, subjective symptomatology, and variable patient reporting. This review aimed to evaluate the potential effectiveness of combining advanced neuroimaging techniques with psychometric testing and blood biomarker analyses for developing a more objective and comprehensive mTBI assessment protocol.

Methods: A review was conducted using PubMed as the primary database, analyzing studies published between 2015 and 2023. Included studies evaluated mTBI (defined as Glasgow Coma Scale score ≥ 14) and incorporated neuroimaging assessment. Studies had to include patients presenting with characteristic mTBI symptoms, such as headache, balance/motor deficits, cognitive impairments, and fatigue. Studies focused on diagnostic accuracy, clinical utility, and integration of different assessment modalities were included.

Results: Advanced neuroimaging techniques, particularly Diffusion Tensor Imaging (DTI), demonstrated superior detection of subtle axonal damage compared to conventional CT and MRI. Specific brain regions, including temporal, fusiform, inferior parietal, and lateral occipital areas, showed promising diagnostic potential. Psychometric assessments, notably the Test of Memory Malingering combined with pupillometry, demonstrated high sensitivity in detecting symptom validity. Blood biomarker analyses revealed S-100B, neurofilament light, and Tau proteins as potential diagnostic indicators, where temporal profiles correlating with symptom progression.

Conclusions: Evidence suggests that integration of multiple diagnostic modalities will significantly enhance mTBI diagnosis accuracy. A multimodal approach is the most effective way to overcome the limitations of individual methods. For example, psychometric tests are relatively subjective, while neuroimaging after an injury is unable to distinguish between pre-existing and new injuries. Devising a clinically relevant multimodal approach will require establishment of standardized norms and studies further validating individual approaches and estimating diagnostic accuracy for combinations of modalities relative to patient outcomes. These findings have particular relevance for Nevada's healthcare system, where rapid and accurate mTBI diagnosis could significantly impact patient care in both urban and rural settings. Future research should focus on validating specific combinations of these techniques and establishing standardized protocols for clinical implementation.

Disciplines

Analytical, Diagnostic and Therapeutic Techniques and Equipment | Medical Sciences | Mental and Social Health | Rehabilitation and Therapy

Keywords

mTBI, Concussion, Malingering, Biomarkers, Psychometric, Imaging, Trauma, Brain

Document Type

Poster

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They’re Faking it! Diagnosing mTBIs using a Multimodal Approach

Purpose: Mild traumatic brain injury (mTBI) affects 69 million people annually worldwide. A significant subset of those affected will develop long-term sequelae that can seriously impact quality of life and lead to other health problems. Clinical diagnosis of mTBI is complicated by patient malingering, subjective symptomatology, and variable patient reporting. This review aimed to evaluate the potential effectiveness of combining advanced neuroimaging techniques with psychometric testing and blood biomarker analyses for developing a more objective and comprehensive mTBI assessment protocol.

Methods: A review was conducted using PubMed as the primary database, analyzing studies published between 2015 and 2023. Included studies evaluated mTBI (defined as Glasgow Coma Scale score ≥ 14) and incorporated neuroimaging assessment. Studies had to include patients presenting with characteristic mTBI symptoms, such as headache, balance/motor deficits, cognitive impairments, and fatigue. Studies focused on diagnostic accuracy, clinical utility, and integration of different assessment modalities were included.

Results: Advanced neuroimaging techniques, particularly Diffusion Tensor Imaging (DTI), demonstrated superior detection of subtle axonal damage compared to conventional CT and MRI. Specific brain regions, including temporal, fusiform, inferior parietal, and lateral occipital areas, showed promising diagnostic potential. Psychometric assessments, notably the Test of Memory Malingering combined with pupillometry, demonstrated high sensitivity in detecting symptom validity. Blood biomarker analyses revealed S-100B, neurofilament light, and Tau proteins as potential diagnostic indicators, where temporal profiles correlating with symptom progression.

Conclusions: Evidence suggests that integration of multiple diagnostic modalities will significantly enhance mTBI diagnosis accuracy. A multimodal approach is the most effective way to overcome the limitations of individual methods. For example, psychometric tests are relatively subjective, while neuroimaging after an injury is unable to distinguish between pre-existing and new injuries. Devising a clinically relevant multimodal approach will require establishment of standardized norms and studies further validating individual approaches and estimating diagnostic accuracy for combinations of modalities relative to patient outcomes. These findings have particular relevance for Nevada's healthcare system, where rapid and accurate mTBI diagnosis could significantly impact patient care in both urban and rural settings. Future research should focus on validating specific combinations of these techniques and establishing standardized protocols for clinical implementation.