title: Utilization of the clinical laboratory for the implementation of concussion biomarkers in collegiate football and the necessity of personalized and predictive athlete specific reference intervals.
abstract: BACKGROUND
  A continued interest in concussion biomarkers makes the eventual implementation of identified biomarkers into routine concussion assessment an eventual reality. We sought to develop and test an interdisciplinary approach that could be used to integrate blood-based biomarkers into the established concussion management program for a collegiate football team.
  
  
  METHODS
  We used a CLIA-certified laboratory for all testing and chose biomarkers where clinically validated testing was available as would be required for results used in clinical decision making. We summarized the existing methods and results for concussion assessment across an entire season to identify and demonstrate the challenges with the eventual integration of a parallel process using blood-based tests for concussion management. We analyzed the results of the biomarkers chosen for trends consistent with the outcome assessments provided from the current concussion management protocols.
  
  
  RESULTS
  Baseline samples were collected with three additional post-concussion samples collected at three separate time points from players with a diagnosed concussion (n = 12). A summary of results from currently used concussion assessment tools were compared to the representative biomarkers S100B and NSE results. Nine sport-related concussions occurred during practice and three during play. For S100B, 50 % had follow-up testing results lower than the post-injury result. In contrast, 92 % of NSE follow-up results were lower than post-injury. One hundred percent of the results for S100B and NSE were within the athlete-derived reference intervals upon return-to-play and season end.
  
  
  CONCLUSIONS
  The reported workflow provides a framework for the eventual implementation of biomarkers for concussion assessment into existing assessment protocols and strengthens the need for reliance on clinical laboratory testing. Athlete-specific reference intervals will be required to adequately interpret results.
authors.affiliation: Department of Psychology, University of Utah School of Medicine, Salt Lake City, UT 84108 USA ; Department of Exercise and Sport Science, University of Utah School of Medicine, Salt Lake City, UT 84108 USA.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulte
authors.affiliation: Department of Pathology, University of Utah School of Medicine, 500 Chipeta Way mail code 115, Salt Lake City, UT 84108 USA ; ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT 84108 USA.
authors.forename: Natalie N
authors.initials: NN
authors.lastname: Rasmussen
authors.affiliation: Department of Athletics, University of Utah School of Medicine, Salt Lake City, UT 84108 USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: McBeth
authors.affiliation: Department of Athletics, University of Utah School of Medicine, Salt Lake City, UT 84108 USA.
authors.forename: Patrick Q
authors.initials: PQ
authors.lastname: Richards
authors.affiliation: Department of Athletics, University of Utah School of Medicine, Salt Lake City, UT 84108 USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Yochem
authors.affiliation: Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT 84108 USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Petron
authors.affiliation: Department of Pathology, University of Utah School of Medicine, 500 Chipeta Way mail code 115, Salt Lake City, UT 84108 USA ; ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT 84108 USA.
authors.forename: Frederick G
authors.initials: FG
authors.lastname: Strathmann
keywords: Biomarker panel; Blood test; Collegiate athletes; Football; NSE; Predictive diagnostics; S100B; Sports-related concussion; Traumatic brain injury
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