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Utilizing UCH-L1 and GFAP Biomarkers as Diagnostic Tools for Concussion in Young Athletes

7 August 2020

Abstract

Background: Sport-related concussions are quickly gaining more attention in society due to the potentially resulting harmful long-term behavioral and cognitive effects. Traditionally, concussions have been diagnosed solely based on clinical symptoms, which can become problematic especially in young athletes who may not fully disclose their symptoms in order to avoid being removed from play. In February 2018, the Food and Drug Administration (FDA) approved the use of a serum assay to diagnose concussions utilizing biomarkers ubiquitin C-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP). While this tool now provides clinicians with an objective way to diagnose concussions, it is indicated only for diagnosis in adults. Thus the lack of an objective “gold standard” in sport-related concussion remains. Therefore, the purpose of this review was to determine if the GFAP and UCH-L1 serum assay could also be utilized as an accurate objective measurement for diagnosing concussion in young athletes.

Methods: A comprehensive search of MEDLINE-PubMed, CINAHL-EBSCO, and Web of Science was conducted using the following keywords: concussion, GFAP, UHC-L1, and sport. The articles were then reviewed for quality and risk of bias.

Results: Of the 3 total articles examined, 2 of them concluded that UCH-L1 had a more prominent role in diagnosing concussion, whereas 1 study found that GFAP is more reliable. However, the studies that supported UCH-L1 specifically examined concussions sustained in young athletes playing sports. The other study took place in the emergency department and analyzed pediatric patients who had been injured in a variety of ways, with the most common of those being sports-related.

Conclusion: More studies that involve larger sample sizes, a wider variety of athletes, and more uniform serum assay characteristics need to be done before this can be considered a reliable diagnostic tool for concussions in this population. However, there appears to be a strong potential for its use in the future, especially when used in combination with the patient’s symptomatology.

Keywords: Concussion, mild traumatic brain injury, biomarkers, UCH-L1, GFAP, sport

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