Objective Markers for Diagnosing Concussions: Beyond Blood Biomarkers and the Role of Real-Time Diagnostic Tools

Concussions, classified as a type of mild traumatic brain injury (mTBI), are frequently underdiagnosed due to the subjective nature of symptoms and limitations in existing diagnostic methodologies. Current clinical evaluations, including tools such as the Sport Concussion Assessment Tool 5 (SCAT5), Balance Error Scoring System (BESS), and Vestibular Ocular Motor Screening (VOMS), demonstrate high sensitivity and specificity but often fail to capture the full complexity of concussive injuries. Emerging diagnostic approaches, such as blood biomarkers (for example, glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), S100 calcium-binding protein B (S100B), and tau) and advanced neuroimaging techniques (for example, diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI)), show promise but remain impractical for routine clinical use due to accessibility and standardization challenges. This review examines objective markers, including neuroimaging, electrophysiological measures (for example, Electroencephalography (EEG), Magnetoencephalography (MEG)), and real-time diagnostic tools, as complementary strategies to enhance traditional clinical evaluations. Findings indicate that while clinical assessments remain central to concussion diagnosis, integrating them with advanced imaging and electrophysiological tools can provide more accurate diagnostics and recovery tracking. Biomarkers, although not yet ready for widespread use, hold significant potential for future applications. Further research is required to validate these methods and establish standardized protocols to facilitate their integration into clinical practice.