Elizabeth Pieroth, PsyD, ABPP, MPH, director of the concussion program at Midwest Orthopaedics at Rush, talks about a new saliva test that could lead to more accurate concussion diagnosis.
So, what’s the traditional pre-saliva test? How do you diagnose concussions?
PIEROTH: Currently, the diagnosis is based on symptoms. So, an athlete says that they’re having a headache, dizziness, nausea, other symptoms are suggestive of concussion or what we call signs, meaning somebody else observed something is not right with the athlete. They’re showing imbalance. They look confused. They’re slow to respond. But there’s a lot of things that can cause those similar symptoms. So diagnosis can be tough, particularly if an athlete wants to hide their symptoms because we don’t have a way of looking at someone saying, you have a concussion. Exactly as Lewis said, we can look at an X-ray and say a bone is broken. We can’t look at a CT scan or an MRI and say somebody had a concussion. We can only use those tests to rule out more serious pathology.
What are the drawbacks of being fairly limited in the tools that you have available right now to diagnose concussions?
PIEROTH: There’s two main drawbacks. One is that we miss a lot of concussions, right? We know that there was a significant problem with underreporting of concussions that athletes are not coming for. There’s some research that suggests as many as, you know, 50 percent of athletes are not reporting their symptoms, which is really problematic for many reasons. We also have the issue of, you know, over-diagnosing concussions, too. It’s a tough balance. We don’t want to say that someone has a concussion unless we have evidence that that’s true. We don’t want either false positives or false negatives. So, anything that helps us with diagnostic accuracy is incredibly useful.
So, in layman’s terms, can you explain the science behind the spit test because it just sounds whacky to me?
PIEROTH: Well, the idea is that there are what they call microRNA parts that are in your saliva. So the idea is that there’s cranial nerves that secrete these small parts of the RNA that they can pick up in saliva. And this is really important because, in the past, other work has looked at things like cerebral spinal fluid, which means a lumbar puncture, which you’re not doing on the side of a soccer game or even just a blood test. So, we’re trying to find some test that’s less invasive. And having an athlete spit into a cup is not very invasive and something that can be done in any location.
Explain the science again. I don’t understand what RNA is.
PIEROTH: So, RNA is part of our genetic picture. And so, in our blood markers are serum markers and other bodily fluids, they can find different biological markers. And the idea is that they’re trying to find a marker that is consistent with brain injury and that’s something else. So as an example, other blood markers that we’ve looked at, we’ll see after someone’s concussion, but we also see it after somebody is exercising. So, it doesn’t really help us looking at athletes with concussions. So, the idea about the saliva test is that it does distinguish between somebody who has a concussion, somebody who is exercising or some other condition. And that’s what’s exciting about this particular saliva test.
How would it work? I know you’re not using it, but how would it work and how long would it take to get results? Is it something that could happen right on the sidelines, or is it kind of like a COVID test where you have to wait a couple of days?
PIEROTH: Yeah, unfortunately, that’s one of the limitations of the study right now, is that it’s taking over 24 hours. So currently, it’s not a test that we can use on a sideline or in an emergency room or an urgent care clinic or something of that, which is really what we want and need. So, it has utility, and my assumption is as the research gets better, we’re going to see a shortening of that response time, which is going to be really helpful. But as it stands right now, that it’s not something that we would be using in real-time yet.
This is kind of be asking about accuracy, I guess, can you kind of speak to the study a little bit? In your opinion, was it a good study?
PIEROTH: The study was actually very well done. They had a high number of subjects, more than 500. They, you know, excluded a number of what we call, you know, confounding variables that we want to not include in the study. They did a very solid job designing the study and they’re very clear about the limitations. You know, this study says that right now, this particular saliva test is not better than what we currently have, meaning neurocognitive test and balance measures. So, it has the same accuracy as that. So those tests can be done on a spot. So, the authors are not suggesting that we, you know, use the saliva test instead of that right now until this test is further studied and further refined. But it really is a very exciting move forward because this is something that we’ve been looking for for a long time. And my hopes is that as it’s further refined, it is going to be something that we can be using on the sidelines.
So just to summarize, what could the potential benefits be to the patient if this test becomes more readily available and acceptable?
PIEROTH: The biggest factor here is improvement in diagnostic accuracy because what we want to do is eliminate those athletes who aren’t yet experiencing symptoms because we can’t see a delayed onset or athletes or patients that are just simply denying those symptoms. So, if we have something that says, yes, in fact, you have a concussion and we can remove them from play and remove them from activities that risk another injury, that’s incredibly helpful. But we also want to improve what we call false positives. We want to make sure that we are not misdiagnosing a concussion when it’s, in fact, something else. So that we can then treat that something else. We don’t want athletes who have to have a history of multiple concussions when that’s not correct. So, finding something that more definitively tells us if a concussion or not is a game changer. It’s a holy grail of concussion work.
There’s the soundbite right there. So last question. We know you weren’t involved in the study but if you had to guess, how far away are clinicians from being able to implement something like this?
PIEROTH: The study didn’t talk about their next step as far as when they thought this might be something that’s commercially available. So, I think we’re still probably a good amount out. But like I said, it’s an important step.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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