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Rugby study identifies new method to diagnose concussion using saliva

Published: 24 March 2021

A study of UK rugby players has identified a method of accurately diagnosing concussion using saliva, paving the way for the first non-invasive clinical test for concussion for use in sport and other settings. 

The team’s previous research identified that the concentration of specific molecules in saliva changes rapidly after a traumatic brain injury. The researchers then embarked on a three-year study in elite rugby to establish if these ‘biomarkers’ could be used as a diagnostic test for sport-related concussion. DNA sequencing technology was used to test these biomarkers in saliva samples from 1,028 professional men’s rugby players competing in English rugby’s top two leagues.

The results of SCRUM (Study of Concussion in Rugby Union through MicroRNAs), published in the British Journal of Sports Medicine, show that these specific salivary biomarkers can be used to indicate if a player has been concussed.  

The research has also found these biomarkers provide further insights into the body’s response to injury as it evolves from immediately after trauma, to several hours and even days later.

The researchers have used this scientific breakthrough to create a new laboratory-based non-invasive salivary biological concussion test. This test could have wide-reaching use and potential to reduce the risk of missing concussions not only in sport, but also in wider settings such as military and healthcare.

In community sport, these biomarkers may provide a diagnostic test that is comparable in accuracy to the level of assessment available in a professional sport setting. While, at an elite level of rugby, the concussion test may be used in addition to the existing World Rugby Head Injury Assessment protocol.

Marker Diagnostics, a subsidiary of Swiss biotechnology company Marker AG, is in the process of commercialising the patented salivary concussion test as an over-the-counter test for elite male athletes. It has also obtained a CE Mark for test, which has been named MDx.100.  

Marker Diagnostics and the University of Birmingham are also currently carrying out several additional studies to further validate and expand the test for use in different groups that were not included in the SCRUM study, including women, young athletes and community sports players.

The study was led by the University of Birmingham, in collaboration with the Rugby Football Union, Premiership Rugby, and Marker Diagnostics. The research is part of the REpetitive COncussion in Sport (ReCoS) research programme being led by the University of Birmingham through the NIHR’s Surgical Reconstruction and Microbiology Research Centre (SRMRC) based at University Hospitals Birmingham NHS Foundation Trust (UHB).

Senior author Antonio Belli, Professor of Trauma Neurosurgery at the University of Birmingham, Consultant Neurosurgeon at UHB, and Director of the NIHR SRMRC, said:  “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.”

Dr Matt Cross, Head of Science and Medical Operations at Premiership Rugby, said:

“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.”


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