December 2, 2020
A device that instantly diagnoses concussion by testing a player’s saliva could be available to use in football by 2022.
Premier League stars are currently taking part in a study, where those who have suffered head injuries have samples of their saliva tested and compared to that of uninjured players.
The research by the University of Birmingham has already found that saliva contains certain testable biomarkers if a concussion has occurred.
And it is hoped club doctors may soon be able to test for that pitch-side using a handheld device – something which would transform in-game concussion assessment, which has come under fresh scrutiny after Arsenal’s David Luiz played on despite his clash of heads with Wolves’ Raul Jimenez on Sunday.
Professor Tony Belli, the academic neurosurgeon who is leading the Premier League study, told Sportsmail: ‘The concussion assessments that are done at the moment are very subjective.
‘We are trying to provide an objective way of confirming whether a player is concussed or not, which will help decision making and will be important at all levels of the game to make players safer.
‘It could be very instructive. You will potentially be able to make a decision within minutes about whether somebody is safe to return to play or if they need to be removed permanently. For somebody where doubts exists, like David Luiz, that is where you would use it.
‘For a device to be used pitch-side, the results would have to be very, very quick. We are still not quite there in terms of speed, even if the accuracy is very good.
‘But the technology is evolving fast. I would say within the next couple of years we will have something that I consider acceptable.’
Belli says test results can currently be processed in 30 minutes but he expects that time could be cut to just one or two minutes in the future, which would make it practical for pitch-side diagnosis.
At the moment, doctors in football must assess for a concussion by looking out for signs and symptoms, such as balance problems and dizziness, and asking players set questions. Even rugby union’s more thorough Head Injury Assessment is a subjective check of symptoms, memory assessment and balance evaluation.
But Belli’s ‘Birmingham Concussion Test’ looks for molecules in saliva, known as microRNAs, which are messengers telling cells what to do in response to trauma. Specific microRNAs have been found that indicate a brain injury – and they therefore act as biomarkers.
Belli and his fellow researchers have already conducted a study in rugby union, taking the saliva samples of Premiership and Championship players in the 2017-18 season.
But with the approval of the PFA and funding from the Drake Foundation, attention has turned to Premier League football, with club doctors taking samples of players immediately after matches in the 2018-19, 2019-20 and 2020-2021 seasons.
Belli, who acts as an independent advisor on concussion for the Premier League, FA and RFU, explained: ‘We take a swab from the floor of the mouth, which takes about 10 seconds. The swab then effectively goes into a feed that extracts the biomarkers, and it comes out with a reading that says the probability of the concussion.
‘If there are no biomarkers, you can be very confident that no concussion has occurred. But if you get a certain level of biomarkers, you can be absolutely certain that someone has had a neurological insult. ‘We are confident that the biomarkers we see are as a result of a concussion. In rugby, even during that very early assessment immediately after a concussion, we can see biomarkers in saliva. There is a signal that develops immediately after a concussion that remains abnormal for several hours or days.
‘Potentially this means that if we get somebody that has just been concussed, you may have the opportunity to make a diagnosis very, very quickly.
‘We finished the rugby research and it is about to go to publication in a major journal. But we didn’t want to just extrapolate from one sport to another because people could argue that concussions in rugby are different to football. We want to prove that what we see in rugby is similar to what we see in football.
‘In football there aren’t as many concussions so it has been a bit slower, but at some point in the next year we will have enough samples. Then we need to develop a method of measuring those biomarkers quickly.’