The Revolution in Concussion Detection
The landscape of traumatic brain injury diagnosis has evolved significantly since the FDA’s groundbreaking 2018 approval of the Banyan Brain Trauma Indicator blood test. For personal injury attorneys representing brain injury victims, these advances represent a crucial tool in overcoming one of the most persistent challenges in TBI litigation: proving that an invisible injury actually occurred.
As Virginia’s only board-certified truck accident attorney and someone who has represented numerous traumatic brain injury survivors throughout my career, I’ve witnessed firsthand how defense counsel exploit the lack of objective evidence in mild TBI cases. The development of blood biomarker testing marks a significant shift in how we can prove these devastating injuries.
Understanding the Banyan Brain Trauma Indicator
The Banyan Brain Trauma Indicator (BTI) works by detecting two specific proteins—ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP)—that are released from the brain into the bloodstream within 12 hours of head injury. When brain cells are damaged through traumatic injury, these proteins leak into the blood, providing measurable evidence of brain trauma.
In the pivotal clinical trial that led to FDA approval, the BTI demonstrated impressive accuracy:
– 97.5% sensitivity in predicting the presence of intracranial lesions on CT scans
– 99.6% specificity in predicting the absence of such lesions
Results are available within three to four hours, making this a practical tool for emergency departments. The test has been validated across approximately 2,000 patients in emergency departments throughout the United States and Europe.
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The Critical Limitation: What the Test Actually Detects
Here’s what every brain injury victim and their attorney must understand: the Banyan Brain Trauma Indicator is designed to identify intracranial bleeding and lesions visible on CT scans—not to diagnose concussions or mild traumatic brain injuries in their most common presentation.
As Dr. Gregory O’Shanick, medical director emeritus of the Brain Injury Association of America, cautioned when the test was approved: “The threshold for detecting brain injury using the BTI is set to the finding of positive results on CT scans, which occurs in the minority of mild TBIs. The majority of concussions have negative CT studies and thus the BTI may not indicate brain injury when, in fact, the patient has sustained a mTBI.”
This limitation is critical from a litigation perspective. The Centers for Disease Control and Prevention estimates that at least 75% of traumatic brain injuries are mild TBIs or concussions that typically show no abnormalities on CT scans. The blood test primarily helps emergency physicians rule out the need for CT imaging in patients who are unlikely to have intracranial bleeding—it doesn’t diagnose the concussions that constitute the vast majority of mild TBI cases.
The Invisible Injury Problem in TBI Litigation
Most car accident, truck accident, and motorcycle accident victims who sustain concussions face a fundamental challenge in personal injury litigation: their injuries are invisible. Unlike a fractured bone or laceration, a concussion typically produces no outward physical evidence and often shows nothing abnormal on standard CT or MRI imaging.
This creates an opening that defense counsel exploit relentlessly. The typical defense strategy in mild TBI cases follows a predictable pattern:
Common Defense Tactics in Concussion Cases
1. Questioning Whether the Injury Occurred At All
Defense attorneys will point to the absence of objective medical findings—normal CT scans, normal MRIs, minimal or no loss of consciousness, and normal Glasgow Coma Scale scores. They’ll argue that without “objective evidence,” the plaintiff’s symptoms are merely subjective complaints that could have multiple explanations. Their first line of defense in mTBI cases is to deny that a mild traumatic brain injury occurred in the first place.
2. Attributing Symptoms to Other Causes
Insurance defense counsel frequently suggest that cognitive difficulties, headaches, and emotional changes result from:
– Pre-existing psychological conditions
– Depression or anxiety unrelated to the accident
– Normal aging
– Stress from the litigation itself
– Medication side effects
– Unrelated medical conditions
3. Attacking Plaintiff Credibility
Defense teams scrutinize medical records for any inconsistencies, no matter how minor. They point to:
– Gaps in treatment (ignoring that many TBI victims don’t recognize their symptoms immediately)
– Variations in symptom reporting across different medical appointments
– Social media posts showing the plaintiff engaged in activities (misrepresenting what cognitive effort those activities actually require)
– Inconsistencies in describing how the accident occurred
4. Suggesting Malingering
Perhaps most offensively, defense experts often insinuate that brain injury victims are exaggerating or fabricating symptoms to enhance their lawsuit value. This attack is particularly cruel given that most TBI survivors are legitimately struggling to understand why they can’t function as they once did.
5. The “No Loss of Consciousness” Argument
Defense counsel frequently argue that without documented loss of consciousness, no brain injury could have occurred. This outdated notion has been thoroughly debunked by medical research, yet it persists in courtrooms because it plays to jurors’ misconceptions about how concussions present.
Clinical Diagnostic Criteria for Mild TBI
Understanding the actual diagnostic criteria for mild traumatic brain injury is essential for building effective cases and countering defense arguments.
The 2023 American Congress of Rehabilitation Medicine (ACRM) Criteria
The most current diagnostic criteria, published by the ACRM in 2023, represent a significant evolution in how mild TBI is diagnosed. These criteria require:
1. A Plausible Mechanism of Injury
– Direct blow to the head
– Head striking an object or surface
– Acceleration/deceleration forces without direct head contact
– Blast or explosion exposure
2. Clinical Signs (Observable or Elicited)
– Loss of consciousness (less than 30 minutes)
– Alteration in mental status (confusion, disorientation)
– Post-traumatic amnesia (less than 24 hours)
– Other acute neurological signs (seizure, focal neurological deficit)
3. Acute Symptoms (Self-Reported)
When clinical signs are not documented, at least two acute symptoms occurring within 72 hours, combined with one clinical or laboratory finding, can support diagnosis. Symptoms include:
– Headache
– Dizziness or balance problems
– Nausea or vomiting
– Vision problems
– Sensitivity to light or noise
– Feeling mentally foggy
– Difficulty concentrating or remembering
– Confusion
– Slowed thinking
4. Important: Loss of Consciousness is NOT Required
Medical research spanning over 35 years has established that loss of consciousness is not necessary for a concussion diagnosis. Nearly 85% of concussion patients experience no documented loss of consciousness yet show measurable changes in orientation, concentration, and memory function immediately after injury.
The CDC explicitly states: “Concussion may occur without loss of consciousness.” Yet defense attorneys continue to exploit this misconception.
Glasgow Coma Scale Limitations
While the Glasgow Coma Scale (GCS) has been used for 51 years to assess TBI severity, it has significant limitations. A mild TBI is typically defined as having a GCS score of 13-15, but this scale was designed to assess consciousness and coma—not to capture the cognitive and functional impairments that devastate many mild TBI survivors.
In May 2025, the National Institutes of Health published a new multi-pillar framework for TBI assessment that expands beyond immediate clinical symptoms to include biomarkers, CT and MRI scans, and contextual factors. This represents an acknowledgment that the traditional approach has failed to adequately capture the true impact of these injuries.
The Role of Blood Biomarker Testing in TBI Litigation
So where does blood biomarker testing fit into the legal landscape of brain injury cases?
Proving Severe Cases
For cases involving intracranial bleeding or visible lesions on CT scans, the BTI provides powerful objective evidence. When these tests return positive, they corroborate the presence of brain trauma with impressive specificity. This can be particularly valuable in wrongful death cases or catastrophic injury litigation where severe TBI occurred.
Limitations for Typical Mild TBI Cases
For the majority of concussion cases—those with no intracranial bleeding and normal CT scans—the current generation of blood tests offers limited utility. A negative BTI test does not rule out concussion; it simply indicates that intracranial bleeding detectable by CT scan is unlikely.
However, this is evolving. Research continues on blood biomarkers that may be able to detect the subtler forms of brain injury that occur in typical concussions. Various studies are examining whether elevated levels of these proteins, even below the threshold for predicting CT abnormalities, correlate with clinical measures of mTBI severity and recovery.
The Age Factor
Research has revealed that the test’s specificity decreases in older patients. In patients 65 and older, specificity dropped significantly because GFAP and UCH-L1 levels tend to be higher even without acute brain injury. This is an important consideration in cases involving older accident victims.
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Building Strong TBI Cases Without Imaging Abnormalities
Given that most concussion cases will not have positive blood biomarker tests or abnormal imaging, what strategies work?
1. Comprehensive Objective Testing
Detailed evaluations provides objective evidence of vision issues, hearing problems, vestibular problems, and cognitive impairments in attention, memory, processing speed, and executive function. These tests document deficits that may not be apparent in casual interaction but significantly impact daily functioning.
2. Consistent Medical Treatment and Documentation
Establishing a clear timeline of symptoms from the accident through ongoing treatment is essential. Every medical provider should document:
– Specific cognitive complaints
– Impact on work performance
– Changes in personality or emotional regulation
– Physical symptoms (headaches, dizziness, vision problems)
– Sleep disturbances
3. Powerful Lay Witness Testimony
Family members, co-workers, and friends who can testify to concrete changes in the victim’s personality, capabilities, and functioning provide compelling evidence. These witnesses should describe specific examples:
– Tasks the person could previously handle but now cannot
– Personality changes they’ve observed
– Social withdrawal or emotional changes
– Memory lapses or confusion in specific situations
4. Vocational and Life Care Experts
For cases involving permanent disability, vocational experts can establish lost earning capacity, while life care planners can project ongoing treatment needs and costs.
5. Qualified Medical Experts
Board-certified neurologists, neuropsychologists, and physiatrists who specialize in brain injury can explain:
– Why CT and MRI scans are typically normal in concussions
– The mechanism of diffuse axonal injury
– Why loss of consciousness is not required for brain injury
– The physiological basis for the victim’s symptoms
– Expected prognosis and future treatment needs
6. Advanced Imaging When Appropriate
While standard CT and MRI may be normal, specialized imaging techniques can sometimes reveal evidence of injury:
– Diffusion Tensor Imaging (DTI) can show white matter damage
– Functional MRI (fMRI) can demonstrate altered brain activity patterns
– Susceptibility-weighted imaging (SWI) may detect microhemorrhages
These imaging studies are not always necessary or appropriate, but in cases where they reveal abnormalities, they provide powerful objective evidence.
The Future of Blood Biomarker Testing
Research continues on expanding the utility of blood biomarkers for concussion diagnosis. Scientists are investigating:
– Whether biomarker levels correlate with symptom severity and recovery
– Biomarkers that may detect sub-concussive impacts
– Using multiple biomarkers in combination
– Point-of-care testing that could be used on athletic fields
The U.S. Department of Defense has invested substantially in this research, given the high incidence of TBI in military populations. As of 2025, the FDA has approved 13 devices for assisting in TBI assessment, with more in development.
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Practical Implications for Brain Injury Victims
If you or a loved one has sustained a traumatic brain injury in an accident, several actions are critical:
Seek Immediate Medical Evaluation
Even if you feel relatively normal after an accident, concussion symptoms can develop hours or days after injury. Emergency evaluation establishes the temporal relationship between the accident and your symptoms—essential for litigation purposes.
Follow Up Consistently
Don’t minimize symptoms or delay seeking care. Regular follow-up with primary care physicians, neurologists, or concussion specialists creates a documented trail of your ongoing symptoms. Gaps in treatment allow defense counsel to argue you weren’t really injured.
Document Everything
Consider keeping a symptom journal noting:
– Daily headaches or other physical symptoms
– Cognitive difficulties (word-finding problems, memory lapses, difficulty concentrating)
– Emotional changes
– Impact on work performance
– Social isolation or relationship difficulties
Don’t Rely Solely on Blood Tests
If a blood test comes back negative, this does not mean you haven’t suffered a brain injury. The majority of concussions will not trigger positive blood biomarker results under current testing thresholds. Continue pursuing appropriate medical care and therapies.
Contact Experienced Counsel Early
Brain injury cases require specialized knowledge of both the medicine and the litigation strategies. Insurance companies know that mild TBI claims are difficult to prove and often make lowball settlement offers, hoping victims will accept inadequate compensation rather than face the challenge of trial.
Understanding the Full Spectrum of Brain Injuries
While this article focuses on mild TBI, it’s important to recognize that brain injuries exist on a spectrum. Some victims suffer more severe injuries with obvious imaging abnormalities and profound deficits. Others TBI survivors can develop complications like bipolar disorder following brain trauma. To get a better understanding of traumatic brain injuries and how they impact litigation, check out The Complete Guide to Traumatic Brain Injury Cases in Virginia.
Regardless of where on this spectrum your injury falls, you deserve representation from an attorney who understands the complexity of these cases and won’t be intimidated by aggressive defense tactics.
Conclusion: A Tool, Not a Solution
Blood biomarker testing represents an important advance in brain injury medicine, but it does not end all challenges of proving mild TBI in litigation. The Banyan Brain Trauma Indicator excels at what it was designed to do—helping emergency physicians determine which patients need CT scans to rule out intracranial bleeding.
For the typical concussion victim—someone with debilitating symptoms, normal imaging, and no intracranial bleeding—blood tests offer limited help under current technology. These cases still depend on comprehensive medical documentation, neuropsychological testing, powerful lay witness testimony, and skilled legal advocacy to overcome defense arguments that the injury never occurred.
As medical science continues advancing, we may see blood biomarkers that can reliably detect and quantify the subtler forms of brain injury that affect millions of Americans each year. Until then, brain injury victims need attorneys who understand both the medicine and the litigation strategies required to secure just compensation.
If you or someone you love has suffered a traumatic brain injury due to someone else’s negligence—whether you need a Virginia truck accident lawyer, a Charlottesville car accident lawyer, a motorcycle collision lawyer, or any other type of incident—it is vital that you receive proper medical evaluation and legal representation to protect your rights.
At MartinWren, P.C., we have extensive experience handling complex brain injury cases throughout Virginia. We understand the science, we know the defense playbook, and we’re prepared to fight for the full compensation you deserve.
For questions about a brain injury case, please contact Robert E. Byrne, Jr. at (434) 817-3100 or by email at [email protected].
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**About the Author:** Robert E. Byrne, Jr. is a personal injury attorney at MartinWren, P.C. in Charlottesville, Virginia. He is Virginia’s only board-certified truck accident attorney through the National Board of Trial Advocacy and has extensive experience representing victims of catastrophic injuries, including traumatic brain injury cases.
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