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J Neurotrauma. 2016 Jan 15;33(2):203-14. doi: 10.1089/neu.2015.4149. Epub 2015 Dec 18.

Ability of Serum Glial Fibrillary Acidic Protein, Ubiquitin C-Terminal Hydrolase-L1, and S100B To Differentiate Normal and Abnormal Head Computed Tomography Findings in Patients with Suspected Mild or Moderate Traumatic Brain Injury.

Author information

1
1 Department of Emergency Medicine, Wayne State University , Detroit, Michigan.
2
2 Department of Emergency Medicine, Washington University , St. Louis, Missouri.
3
3 Department of Anesthesiology and Intensive Care, Clinical Sciences in Malmo , Malmo, Sweden .
4
4 Department of Radiology, University of California San Diego Health System , San Diego, California.
5
5 Berry Consultants , Austin, Texas.
6
6 Department of Emergency Medicine, University of Florida , Gainesville, Florida.
7
7 Neurostudies.net , Decatur, Georgia .
8
8 Department of Neurosurgery, Pecs University , Pecs, Hungary .
9
9 Department of Neurosurgery, University of Szeged , Szeged, Hungary .
10
10 U.S. Army Medical Research and Materiel Command , Fort Detrick, Maryland.
11
11 Applied Neurobiology, Silver Spring, Maryland.
12
12 Center for Military Psychiatry and Neuroscience Walter Reed Army Institute of Research , Silver Spring, Maryland.
13
13 Center of Innovative Research, Banyan Biomarkers, Inc. , Alachua, Florida.
14
14 Department of Radiology, University of Pennsylvania , Philadelphia, Pennsylvania.
15
15 Department of Radiology, Shields Health Care Group , Brockton, Massachusetts.
16
16 Department of Emergency Medicine, University of Rochester School of Medicine , Rochester, New York.

Abstract

Head computed tomography (CT) imaging is still a commonly obtained diagnostic test for patients with minor head injury despite availability of clinical decision rules to guide imaging use and recommendations to reduce radiation exposure resulting from unnecessary imaging. This prospective multicenter observational study of 251 patients with suspected mild to moderate traumatic brain injury (TBI) evaluated three serum biomarkers' (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1] and S100B measured within 6 h of injury) ability to differentiate CT negative and CT positive findings. Of the 251 patients, 60.2% were male and 225 (89.6%) had a presenting Glasgow Coma Scale score of 15. A positive head CT (intracranial injury) was found in 36 (14.3%). UCH-L1 was 100% sensitive and 39% specific at a cutoff value >40 pg/mL. To retain 100% sensitivity, GFAP was 0% specific (cutoff value 0 pg/mL) and S100B had a specificity of only 2% (cutoff value 30 pg/mL). All three biomarkers had similar values for areas under the receiver operator characteristic curve: 0.79 (95% confidence interval; 0.70-0.88) for GFAP, 0.80 (0.71-0.89) for UCH-L1, and 0.75 (0.65-0.85) for S100B. Neither GFAP nor UCH-L1 curve values differed significantly from S100B (p = 0.21 and p = 0.77, respectively). In our patient cohort, UCH-L1 outperformed GFAP and S100B when the goal was to reduce CT use without sacrificing sensitivity. UCH-L1 values <40 pg/mL could potentially have aided in eliminating 83 of the 215 negative CT scans. These results require replication in other studies before the test is used in actual clinical practice.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01295346.

PMID:
26467555
PMCID:
PMC4722555
DOI:
10.1089/neu.2015.4149
[Indexed for MEDLINE]
Free PMC Article

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