The use of fieldside saliva tests to diagnose a concussion is one more step after a ‘game-changing’ trial among elite male rugby players.
Researchers took samples from 156 Premiership and Championship players who underwent Head Injury Assessments (HIA) during the 2017-18 and 2018-19 seasons.
Using microscopic DNA markers in saliva, they did a test that predicted an HIA result with 94% accuracy.
However, the test cannot yet be used on women due to a lack of data.
The study’s chief investigator, Professor Antonio Belli, said this represented an “opportunity to beat the drums for more of this research to be done in groups that are not traditionally included.”
Prof Belli described the study’s results as “game-changing,” adding: “When I see on television that a player is taken in for the medical saliva test, it will be a major achievement. “
While a lab test could be used in the next few months for elite players, a fieldside test that provides instant results could be several years away.
The new technology could also be used beyond sport, potentially in general medicine and in the military.
What are the results of the study?
The three-year study was carried out by the University of Birmingham, in collaboration with the Rugby Football Union (RFU), Premiership Rugby and Marker Diagnostics, a company specializing in biomarkers.
Dr Simon Kemp, director of medical services at RFU, described the results as “incredibly exciting” and said the potential of the test was “far greater than rugby”.
He told BBC Sport: “This applies to all head injuries, but in a rugby context, we know you can get a change in biomarkers very quickly so that you can take a test in a medical room when you are out. a match and that could certainly be returned. the next day in the elite match. ”
Belli said the study was a “breakthrough” and that he had “never really seen something so exciting” in an area of work that previously relied on blood samples.
He explained, “Blood is much harder to work with and doesn’t really work for a field test or for children.
“Now you have something that is non-invasive, fairly easy to obtain, objective and precise at the same time. “
Further steps in the study will focus on brain damage in retired contact sports players, with Professor Belli confident that they will “soon have something exciting”.
The RFU, World Rugby and the Welsh Rugby Union face off a lawsuit brought by retired players suffering from dementia premature.
Could it be used in football?
The Premier League conduct separate studies in the early signs of dementia and is in talks to collaborate with the University of Birmingham team around three-minute concussion replacement rules.
The saliva test is in the lab, but the speed of test development after the Covid-19 outbreak could see this change rapidly.
Professor Belli said that concussion biomarkers are present in saliva “within minutes” of injury, that a three-minute test was “theoretically possible” and that the study was planned to be extended to these. domains in the next few years.
What about outdoor sport?
Professor Belli underlined the potential for the use of the saliva test in military conflicts, as well as its “quite important” character for the national health service.
He said that between a third and a half of head injuries in traffic accidents may go undiagnosed, adding: “Being able to make that diagnosis from a simple test could potentially change the outcome for this patient. . “
And the use of the test can extend beyond concussion.
“It is quickly becoming of interest as a possible target for liquid biopsies for cancer and heart attacks, and other conditions that would normally require a blood test,” said Professor Belli.
“If you can get the data from the saliva, you can get it from a GP and test the children, that opens up a number of avenues. “
What about concussions in women?
Professor Belli believes that women suffer from symptoms “more severe and more prolonged” than men and that “to say that this test would work in women would be a mistake”.
Dr Kemp said: “In the women’s international match, we run the HIA, we don’t do it in the women’s national match. There are real aspirations for this to change very quickly and it would be one of my personal goals to help that. ”
The RFU hopes to collect data during the “next phase” of the Premier 15 women, and had wanted to do the same during the Rugby World Cup, which was postponed due to Covid-19.
What happens next?
The current results will be presented at the World Rugby Symposium later this month with the hope that two more world competitions will join the study to collect data, refine the algorithm and provide independent verification of the results.