High-Performance Core Laboratory GFAP/UCH-L1 Test for Intracranial Injury Prediction After Mild Traumatic Brain Injury
Authors: Robert D. Welch, Jeffrey J. Bazarian, James Y. Chen, et al.
Journal: American Journal of Emergency Medicine, 2024
Conclusions
- The GFAP/UCH-L1 biomarker panel analyzed on a core lab-based high-throughput platform demonstrates high sensitivity and negative predictive value for detecting traumatic intracranial injuries in mild TBI.
- This platform enables simultaneous analysis of multiple samples, making it valuable during mass casualty events or high-volume emergency department scenarios.
- These findings support the biomarker panel as a reliable tool for ruling out the need for unnecessary CT scans, improving efficiency and resource utilization in emergency settings.
Methods
- Study Design: Secondary analysis of data and banked blood samples from the ALERT-TBI study.
- Inclusion Criteria:
- Adults (≥18 years) with nonpenetrating head injury.
- Glasgow Coma Scale (GCS) score of 13–15.
- Head CT performed due to suspected traumatic brain injury.
- Primary Outcome: Test characteristics of GFAP/UCH-L1 biomarker panel compared to head CT findings.
Results
- Sample Size: 1,899 patients.
- Mean Age: 49.1 years (range: 18–98 years).
- Gender: 56.5% male.
- Mechanism of Injury: Falls (51.9%).
- GCS Score: 94.1% had a GCS of 15.
- Head CT Findings:
- 120 patients (6.3%) had traumatic intracranial injuries.
- 4 false-negative results from the biomarker panel.
- Performance Metrics:
- Sensitivity: 96.7% (95% CI: 91.7–98.7).
- Specificity: 40.1% (95% CI: 37.8–42.4).
- Negative Predictive Value (NPV): 99.4% (95% CI: 98.6–99.8).
- Negative Likelihood Ratio: 0.08 (95% CI: 0.03–0.22).
Welch, R.D., Bazarian, J.J., Chen, J.Y., Chandran, R., Datwyler, S.A., McQuiston, B. and Caudle, K., 2024. A high-performance core laboratory GFAP/UCH-L1 test for the prediction of intracranial injury after mild traumatic brain injury. The American Journal of Emergency Medicine.