A “game changer” saliva test to detect concussion has been unveiled by the University of Birmingham in conjunction with England’s Rugby Football Union.
The scientific breakthrough, which accurately identifies traumatic brain injury, follows a study of over 1,000 professional male rugby players competing in the English Premiership and Championship, over two seasons between 2017 and 2019.
The saliva test could significantly improve the effectiveness of rugby’s return to play protocols as early as next season due to laboratory results, which are 94 per cent accurate, being available within 24 to 36 hours.
Currently, a player must undergo a six-day process to be deemed fit to resume playing after failing an initial head injury assessment (HIA).
"This is a real game changer and provides an invaluable tool for clinicians to diagnose concussion more consistently and accurately," said Prof Antonio Belli, a trauma neurosurgeon and senior author of the research paper published in the British Journal of Sports Medicine. "What is really exciting about all of this is we have found a very accurate way of identifying brain trauma but also we have found it in saliva, which is not invasive.
“Everybody, including myself, have been looking in blood for many, many years.”
It is anticipated that further research will produce a rapid pitchside test, for all contact sports, that can be used in tandem with rugby’s current HIA.
“The next stage would be to make it faster and instantly available to the doctor on the bench,” said Prof Belli.
The “salivary concussion test” has already been patented and is being commercialised by Marker Diagnostics, a subsidiary of the biotechnology company Marker AG, to sell as an “over-the-counter test for elite male athletes.”
“Although this has started in a sporting setting, the potential ramifications are enormous,” said Dr Patrick O’Halloran, a scientist employed by Marker Diagnostics and a matchday medic for Worcester Warriors. “In terms of having this measurable biological signal, it helps us to diagnose the injury, how we can monitor it and potentially even where we can intervene with treatments to try and improve the quality of life for people after this injury.”
Further research is planned across two professional men’s rugby competitions to enhance the current data. The study also needs to be replicated on women and children before it can be used in amateur and community sport.
"We would envisage the first place that this saliva test might really add value is 24 hours after the elite game," said Dr Simon Kemp, medical director of the RFU. "We want to use it to improve the performance of the head injury assessment.
"If we can validate the biomarker in the community game setting, its biggest potential value would be for people within sport, the military and general population who do not typically get the same clinical assessment as Owen Farrell got on Saturday."
Farrell, the England captain, was removed from last weekend's Six Nations match in Dublin for a HIA after the independent matchday doctor reviewed footage of a collision with Ireland's Iain Henderson. Farrell initially resisted the decision but he did not return to the field.
“I think it is incredibly important to stress,” Dr Kemp added, “that we have tested players we know to be concussed, players who are possibly concussed but were not deemed to be concussed, players who had other musculoskeletal injuries and players who played the whole game, so it was a very robust study design.”
The research and study was prompted by an informal discussion between Prof Belli and Dr Kemp at the 2016 Berlin international conference on concussion in sport.
Saliva samples were collected pre-season from 1,028 players. They were also collected from 156 of these players at three points during their HIA process; in-game, post-game and 36-48 hours after the suspected brain injury occurred.
The HIA includes a neurological examination, a series of cognitive tests and evaluation of gait and balance to determine if a player has been concussed.
Dr Éanna Falvey, World Rugby’s chief medical officer and a former Irish boxing champion, commended the saliva test research ahead of the governing body’s welfare symposium later this month.
“This study, its rigour and outcomes demonstrate the value in a targeted, scientific approach and reflects rugby’s progressive commitment to player welfare,” said Dr Falvey.
The test does not reveal sub-concussive injury despite the current legal action being taken by retired professional rugby players, who are suffering from early onset of dementia, stating, via Rylands Law firm, that World Rugby and the English and Welsh governing bodies had a duty “to take such steps and to devise and implement such rules and regulations as were required in order to remove, reduce or minimise the risks of permanent brain damage as a consequence of the known and foreseeable risk of concussive and sub-concussive injuries.”
“We didn’t explore that question with this particular study,” added Prof Belli. “It is a very good question; rugby, football and other sports, where a player may be exposed to a sub-concussive injury, what would happen to those biomarkers?”
