AI Article Synopsis
- A blood biomarker panel including GFAP and UCH-L1 can potentially replace head CT scans for certain patients with traumatic brain injury (TBI), as it shows high sensitivity and negative predictive values.
- In a study with 1,899 TBI patients, the panel accurately identified the presence of traumatic intracranial injury in most cases, with a low false-negative rate.
- The core lab-based platform allows for rapid analysis of multiple samples, which is particularly useful in urgent situations like mass casualty events or busy emergency departments.
Article Abstract
Background: A glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) blood biomarker panel can reliably eliminate the need to perform a head computed tomography (CT) scan in selected patients with traumatic brain injury (TBI). Currently, this FDA cleared panel can be run both on a core laboratory platform or a hand-held single-sample point of care platform. This study examined test characteristics of the panel as analyzed on a core lab-based fast high-throughput platform.
Methods: This secondary analysis of clinical data and banked blood samples obtained for the ALERT-TBI study included patients ≥18 years old with nonpenetrating head injury, a presenting Glasgow Coma Scale score 9-15, and a head CT was indicated. Included were patients with a GCS 13-15 who had sufficient banked blood for analysis. Test characteristics of the biomarker panel were determined relative to head CT findings for traumatic intracranial injury.
Results: Among the 1899 included subjects, mean age was 49.1 yrs. (18 to 98 yrs), 56.5 % male, and 70.6 % were Caucasian. The most common mechanism of injury was a fall (51.9 %) and 94.1 % presented with a GCS of 15. Head CT was positive for traumatic intracranial injury in 120 patients (6.3 %) of which the biomarker panel was a false negative in four patients. Sensitivity (95 % confidence interval) of the biomarker panel was 96.7 (91.7, 98.7), specificity 40.1 (37.8, 42.4), negative predictive value 99.4 (98.6, 99.8), and the negative likelihood ratio was 0.08 (0.03, 0.22).
Conclusions: The biomarker panel, measured on this core lab-based fast high-throughput platform, had high sensitivity and negative predictive values. The core laboratory platform has the advantage of speed and the ability to analyze multiple samples simultaneously suggesting additional utility when there is high need for CT imaging such as mass casualty or emergency department volume overload situations.
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| http://dx.doi.org/10.1016/j.ajem.2024.12.005 | DOI Listing |
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