Traumatic brain injury (TBI) happens when a bump, blow, jolt, or other head injury causes damage to the brain.

Every year, millions of people in the U.S. suffer brain injuries, including people over 65, for whom TBI is serious and widespread enough to have been referred to as a “silent epidemic.”

In older adults, traumatic brain injury is responsible for more than 80,000 emergency department visits each year, with three-quarters of these visits resulting in hospitalization, according to a research article by Hilaire J. Thompson, Ph.D.; Wayne C. McCormick, M.D., M.P.H.; and Sarah H. Kagan, Ph.D., and published by the U.S. National Library of Medicine (

The report also found that adults aged 75 and older have the highest rates of TBI-related hospitalization and death. Falls are the leading cause of TBI for older adults (51%), and motor vehicle traffic crashes are second (9%).

Symptoms of a TBI may not appear until days or weeks following the injury. A concussion is the mildest type and can cause a headache or neck pain, nausea, ringing in the ears, dizziness, and tiredness.

People with a moderate or severe TBI may have those, plus other, symptoms:


• A headache that gets worse or does not go away

• Repeated vomiting or nausea

• Convulsions or seizures

• Inability to awaken from sleep

• Slurred speech

• Weakness or numbness in the arms and legs

• Dilated eye pupils


TBI, which requires emergency treatment, can also cause a wide range of changes affecting thinking, sensation, language, or emotions.

The American College of Emergency Physicians recommends that all elderly concussion patients undergo computed tomography (CT) scans to check for intracranial bleeding, because issues such as age-related cognitive decline or dementia can mask signs of bleeding-induced mental impairment.

However, CT scans are very expensive and expose patients to radiation, and both the healthcare system and patients would benefit from reduced CT scan use.

New research, however, shows that a blood test can differentiate elderly concussion patients with brain tissue damage from those without it.

This finding, published recently in the special brain health collection of AACC’s The Journal of Applied Laboratory Medicine, could help ensure that elderly patients with severe concussions receive crucial treatment for their injuries.

The Food and Drug Administration had previously authorized a blood test that identifies head injury patients who have brain tissue damage that needs to be assessed via CT scan, but the blood test was not specifically designed for older patients.

So a team of researchers led by Robert H. Christenson, Ph.D., of the University of Maryland School of Medicine in Baltimore, set out to determine how well the test performs in patients age 65 years or older.

To do this, Christenson’s team retrospectively analyzed data from the Prospective Clinical Evaluation of Biomarkers of Traumatic Brain Injury (ALERT-TBI) study, in which 1,959 adult patients with a concussion underwent both a CT scan and blood test for brain tissue damage within 12 hours of their injury.

Christenson’s team compared the results of the CT scan and blood test — which measures two specific proteins — in patients 65 years of age or older and in patients younger than 65.

From this comparison, the researchers found the blood test predicts with 100% accuracy which elderly concussion patients do not have brain tissue damage and do not need a CT scan.

Hospitals can therefore use this test to triage elderly concussion patients so that clinicians can focus on those most likely to require urgent intervention for intracranial bleeding.

Importantly, however, the researchers also found that the test does not accurately identify elderly patients who do have brain tissue damage, which means that the test should only be used as a triage tool, not as a replacement for CT scans.

For more information, visit the Centers for Disease Control and Prevention’s TBI webpage at

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