• Evidentiary Value of TBI Biomarkers in Personal INjury Case Management

    Objective TBI Diagnostics. Clearer Cases. Smarter Resolutions.

  • Traumatic Brain Injury is one of the most complex and costly personal injury claims

    Conventional TBI Diagnostics are Subjective, Inconsistent, and Often Contested

    Biomarkers Provide an Objective Measure of Neurotrauma

    Biomarker testing measures brain-derived proteins and risk indicators to provide objective evidence of traumatic brain injury – supporting clinical assessment, risk stratification, and individualized care planning.

    How Biomarker Testing Informs Clinical Evaluation

    When ordered by a licensed treating provider and supported by qualified subspecialists for clinical decision support and multidisciplinary care planning, biomarker testing:

    • Supports confirmation or rule-out of traumatic brain injury
    • Informs assessment of injury severity
    • Assists with risk stratification and prognosis
    • Enables longitudinal monitoring of recovery or persistent injury activity

    Biomarker results are not used in isolation and are interpreted in conjunction with clinical evaluation, history, and other diagnostic findings.

    Limitations of Conventional TBI Diagnostic Tools

    The current standard of care for traumatic brain injury (TBI) evaluation is heavily weighted toward the acute post-injury period, typically within the first 24 to 72 hours. During this window, structural imaging studies such as CT and MRI are primarily used to identify gross abnormalities, including intracranial bleeding, skull fractures, or other acute structural injuries. While essential for detecting life-threatening conditions, these imaging modalities are not designed to detect the subtle cellular and axonal injuries that characterize many mild-to-moderate TBIs (mmTBI).

    Beyond the acute period, objective diagnostic tools become increasingly limited. Clinical evaluation often shifts to symptom inventories, neurocognitive screening tools, and functional assessments, which rely largely on patient self-reporting and subjective performance measures. These tools can be influenced by recall bias, symptom under- or over-reporting, comorbid conditions, and psychosocial factors, and they provide limited biological insight into whether brain injury is present, ongoing, or resolving.

    As a result, many mmTBI cases – particularly those without overt radiographic findings – may be missed, misclassified, or difficult to definitively confirm once the acute window has passed. This can lead to delayed recognition, inconsistent longitudinal management, and potentially avoidable long-term neurological compromise, including persistent post-concussive symptoms (PCS), cognitive or functional impairment, and increased long-term disability risk.

    Biomarker-Based Pathways vs. Conventional Evaluation

    • Objective Evidence – Strengthens the evidentiary foundation of subjective, symptom-based assessment through measurable biological data
    • Treatment - Supports early, targeted interventions that can optimize recovery outcomes
    • Risk Stratification – Informs prognosis and supports individualized care planning
    • Longitudinal Monitoring – Enables serial reporting of neurological status to evaluate recovery, detect ongoing neurodegeneration, and assess cumulative exposure

  • Biomarker testing offers the assurance that neurocognitive injuries are fully considered as part of your case, supporting comprehensive and defensible claims

  • Clinically Established Biomarkers Used in TBI Evaluation

    TBI diagnostic pathways commonly rely on a defined set of clinically validated neurotrauma-related protein biomarkers and selected genetic variants, each of which reflects distinct biological processes related to brain injury, recovery, or individual response.

    Brain Injury Biomarkers (Objective Evidence of Neuronal Injury)

    Proteins released following traumatic brain injury:

    • GFAP (most informative in the early post-acute period; generally up to ~12 weeks post-injury)
    • NfL / NfH (useful for subacute and chronic assessment; approximately ~6 weeks to several years post-injury)
    • BD-p-tau (useful for subacute and chronic assessment; approximately ~6 weeks to several years post-injury)
    • UCH-L1 (primarily informative in the acute to early post-acute period; generally within ~6 weeks post-injury)
    • S100B (acute-phase biomarker; typically informative only within ~72 hours post-injury)

    These biomarkers may provide objective confirmation or rule-out of brain injury when ordered by and interpreted by a treating physician.

    Neurodegenerative / Differential Biomarkers

    Proteins associated with neurodegenerative pathology:

    • p-tau217 (Used to support differential diagnosis and longitudinal assessment; not specific to traumatic injury)

    Predictive / Susceptibility Biomarkers

    Genetic variants that may inform individual response to injury

    • APOE variants – risk, prognosis, recovery trajectory
    • MTHFR variants – metabolic processing
    • IL6R variants – inflammatory response

    These biomarkers do not diagnose injury, but may inform recovery planning or clinical context when considered by a treating provider.

    Timing of Biomarker Testing in TBI Cases

    One of the key advantages of biomarker-based evaluation is the extended testing window relative to conventional TBI assessment tools. While the optimal window for the broadest range of biomarkers is generally ~30 days to 12 weeks post-injury, clinically meaningful and accurate results may still be obtained well beyond the acute period, including up to ~5 years after injury, depending on the biomarkers ordered and the clinical question being addressed.

    Through specialist-supported workflows, treating providers may access biomarkers appropriate for evaluation across multiple phases of injury and recovery, including:

    • Optimal Window: ~30 days to 12 weeks post-injury
    • Extended / Plausible Window: up to ~5 years post-injury

    The clinical relevance and interpretive value of specific biomarkers vary based on time since injury, injury characteristics, symptom course, and individual patient factors, and are determined by the treating provider with specialist support as appropriate.

    Medical Decision-Making Framework

    Biomarker testing is not a substitute for medical evaluation, and BioConnetiX does not determine medical necessity, diagnosis, or treatment. All testing decisions and interpretations are made exclusively by licensed treating providers.

  • Redefine What's Possible in Personal Injury Case Outcomes

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