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Saliva Test Could Better Diagnose Concussions in Kids, Penn State Researchers Say

by on November 22, 2017 11:15 AM

Diagnosing concussions in children isn't always easy, and predicting how long they'll last is even harder. But a new study from Penn State College of Medicine researchers says the answer may be a little bit of spit.

The new study, published this week in The Journal of the American Medical Association (JAMA) Pediatrics, found that the presence of some microRNAs in saliva identified concussions and predicted duration of symptoms better than only surveying patients.

MicroRNAs are tiny pieces of noncoding RNA that affect how genes are expressed in different conditions such as injury. The researchers believed these could potentially predict the presence and length of a concussion.

“There’s been a big push recently to find more objective markers that a concussion has occurred, instead of relying simply on patient surveys,” said Steven Hicks, assistant professor of pediatrics, in a news release. “Previous research has focused on proteins, but this approach is limited because proteins have a hard time crossing the blood-brain barrier. What’s novel about this study is we looked at microRNAs instead of proteins, and we decided to look in saliva rather than blood.”

Hicks, one of seven College of Medicine researchers involved in the study, is a general pediatrician who often sees children with concussions. He said diagnosis and management of concussions are subjective -- doctors conduct a physical exam and survey the patient about their symptoms, which can include headache, nausea, confusion and amnesia. 

"Then, we make an educated guess about how long that child might continue to have a headache or feel nauseous," Hicks said. "But those guesses aren't evidence-based and aren’t always accurate.”

Concussion symptoms usually clear up within about two weeks but about a third of patients experience symptoms for a longer period. Patients are advised to rest and avoid physical activities like sports, but how long they should rest is difficult to predict.

Nearly two-thirds of diagnosed concussions occur in children.

Predicting early on how long a concussion will last would help patients get the right type of care from the start.

The new study involved 52 concussion patients between the ages of 7 and 21. Each was evaluated with the commonly-used Sport Concussion Assessment Tool within two weeks of injury and parents were asked for observations about symptoms. 

Saliva also was collected from each participant. Researchers analyzed it for levels of microRNAs then compared the profiles to patients symptoms over time.

Five microRNAs were isolated that could identify the patients who experienced prolonged symptoms at a much higher rate of accuracy than relying on assessments and observations.

“The microRNAs were able to predict whether symptoms would last beyond four weeks with about 85 percent accuracy,” Hicks said. “In comparison, using the SCAT-3 report of symptoms alone is about 64 percent accurate. If you just go off the parent’s report of symptoms, it goes down to the mid-50s. In this pilot study, these molecular signatures are outperforming survey tools.”

Additional study is needed, but Hicks is hopeful testing saliva will eventually make for quick and accurate concussion diagnosis..

“The ultimate goal is to be able to objectively identify that a concussion has happened and then predict how long the symptoms will go on for,” he said. “Then we can use that knowledge to improve the care that we provide for children who have concussions, either by starting medicine earlier or holding them out of activities for longer.”

The study was supported by The Children's Miracle Network and Quadrant Biosciences.

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