‘It’s game-changing’ – new test can detect concussion through saliva

The RFU‘s medical services director has hailed a new ‘extremely encouraging’ method of diagnosing concussions in rugby players through testing saliva.

Dr Simon Kemp has representated the RFU in its collaborative efforts with the University of Birmingham, which has led a study into bio-markers that can confirm concussions when detected.

Also supported by Premiership Rugby (PRL) and the Rugby Players Association (RPA), the conclusions of the study have been published in the British Journal of Sports Medicine this week.

It involved medical professionals at the University of Birmingham’s National Institute for Health Research’s Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC) and specialists in trauma neurosurgery testing 1,028 rugby players competing in the Premiership and Championship.

Their work using DNA has been able to analyse saliva for markers which typically present when a concussion happens.

Described as a ‘game-changing’ development, the test is in the process of being made available as an over-the-counter test to become available far beyond the echelons of elite rugby and sport.

RFU medical director, Dr Kemp said: “This study is an important part of the portfolio of collaborative research initiatives the RFU undertakes into concussion.

“While still a way from having something that can be used in community rugby, it is extremely encouraging to now be able to start to develop a rapid and non-invasive test which could add real value particularly at a grassroots level of the game.

“We would like to thank all the players and clubs who participated in the study and to World Rugby for granting permission for us to extend the duration of the HIA from 10 to 13 minutes in order for the saliva samples to be captured. We wouldn’t have been able to do it without this support.

“We will now be working with World Rugby to secure further research options in two elite men’s competitions.”

In December, rugby faced new realities of how concussion has been linked to chronic neurological diseases after former Test stars, including World Cup-winner Steve Thompson, Alix Popham and Michael Lipman, went public with their early-onset dementia diagnoses and probably CTE (Chronic Traumatic Encephelopathy).

More than 130 former players joined arms to bring legal action against World Rugby, the RFU and WRU for failing to protect them against the risks posed by concussions.

And while that remains a separate issue, the development of saliva tests is a significant step to better detection of concussion.

Dr Matt Cross, head of science and medical operations at Premiership Rugby, said: “We would like to thank our clubs and all of the players for volunteering to be part of this very important research project.

“The findings from the study are clearly promising and highlight the potential for salivary biomarkers to further support clinical decision making and the accurate identification and diagnosis of concussion in a range of different sporting and non-sporting settings.

“Premiership Rugby and the Premiership clubs support a number of player welfare focused research projects, and we are looking forward to continuing to collaborate and support further research in the next phase of this specific project from 2021-22 onwards.”

First author Dr Valentina Di Pietro, of the University of Birmingham and NIHR SRMRC, said: “Concussion can be difficult to diagnose, particularly in settings such as grass roots sports where evaluation by a specialist clinician is not possible. Consequently, some concussions may go undiagnosed.

“There are also concerns regarding the long-term brain health of those exposed to repeated concussions.

“A non-invasive and accurate diagnostic test using saliva is a real game changer and may provide an invaluable tool to help clinicians diagnose concussions more consistently and accurately.

“In professional sports, this diagnostic tool may be used in addition to current head injury assessment protocols and return to play evaluation to ensure the safety of individuals.”

Senior author Antonio Belli, Professor of Trauma Neurosurgery at the University of Birmingham, Consultant Neurosurgeon at UHB, and Director of NIHR SRMRC, added:  “Conducting a study in a professional contact sports setting has meant we have been able to collect invaluable data enabling us to make significant advances in our biological knowledge and understanding of concussion and its diagnosis.

“Crucially, the differences in the salivary concentration of these biomarkers are measurable within minutes of injury, which means we can make rapid diagnoses.

“The ability to rapidly diagnose concussion using biomarkers in addition to existing tools solves a major unmet need in the sporting world as well as in military and healthcare settings, particularly in injuries without significant visible symptoms.”