Papa Linda, Mittal Manoj K, Ramirez Jose, Ramia Michelle, Kirby Sara, Silvestri Salvatore, Giordano Philip, Weber Kurt, Braga Carolina F, Tan Ciara N, Ameli Neema J, Lopez Marco, Zonfrillo Mark
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.
2 Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children , Orlando, Florida.
J Neurotrauma. 2016 Jan 1;33(1):58-64. doi: 10.1089/neu.2015.3869. Epub 2015 Jun 3.
In adults, glial fibrillary acidic protein (GFAP) has been shown to out-perform S100β in detecting intracranial lesions on computed tomography (CT) in mild traumatic brain injury (TBI). This study examined the ability of GFAP and S100β to detect intracranial lesions on CT in children and youth involved in trauma. This prospective cohort study enrolled a convenience sample of children and youth at two pediatric and one adult Level 1 trauma centers following trauma, including both those with and without head trauma. Serum samples were obtained within 6 h of injury. The primary outcome was the presence of traumatic intracranial lesions on CT scan. There were 155 pediatric trauma patients enrolled, 114 (74%) had head trauma and 41 (26%) had no head trauma. Out of the 92 patients who had a head CT, eight (9%) had intracranial lesions. The area under the receiver operating characteristic curve (AUC) for distinguishing head trauma from no head trauma for GFAP was 0.84 (0.77-0.91) and for S100β was 0.64 (0.55-0.74; p<0.001). Similarly, the AUC for predicting intracranial lesions on CT for GFAP was 0.85 (0.72-0.98) versus 0.67 (0.50-0.85) for S100β (p=0.013). Additionally, we assessed the performance of GFAP and S100β in predicting intracranial lesions in children ages 10 years or younger and found the AUC for GFAP was 0.96 (95% confidence interval [CI] 0.86-1.00) and for S100β was 0.72 (0.36-1.00). In children younger than 5 years old, the AUC for GFAP was 1.00 (95% CI 0.99-1.00) and for S100β 0.62 (0.15-1.00). In this population with mild TBI, GFAP out-performed S100β in detecting head trauma and predicting intracranial lesions on head CT. This study is among the first published to date to prospectively compare these two biomarkers in children and youth with mild TBI.
在成人中，研究表明，在轻度创伤性脑损伤（TBI）的计算机断层扫描（CT）中检测颅内病变时，胶质纤维酸性蛋白（GFAP）的表现优于S100β。本研究调查了GFAP和S100β在检测受创伤儿童和青少年颅内病变方面的能力。这项前瞻性队列研究纳入了两个儿科和一个成人一级创伤中心的儿童和青少年便利样本，这些儿童和青少年均遭受过创伤，包括有头部创伤和没有头部创伤的患者。在受伤后6小时内采集血清样本。主要结局是CT扫描上是否存在创伤性颅内病变。共纳入155例儿科创伤患者，其中114例（74%）有头部创伤，41例（26%）没有头部创伤。在进行头部CT检查的92例患者中，有8例（9%）存在颅内病变。GFAP区分有无头部创伤的受试者工作特征曲线（AUC）下面积为0.84（0.77 - 0.91），S100β的为0.64（0.55 - 0.74；p<0.001）。同样，GFAP预测CT上颅内病变的AUC为0.85（0.72 - 0.98），而S100β的为0.67（0.50 - 0.85）（p = 0.013）。此外，我们评估了GFAP和S100β在预测10岁及以下儿童颅内病变方面的表现，发现GFAP的AUC为0.96（95%置信区间[CI]0.86 - 1.00），S100β的为0.72（0.36 - 1.00）。在5岁以下儿童中，GFAP的AUC为1.00（95%CI 0.99 - 1.00），S100β的为0.62（0.15 - 1.00）。在这个轻度TBI人群中，GFAP在检测头部创伤和预测头部CT上的颅内病变方面表现优于S100β。本研究是迄今为止首次发表的前瞻性比较这两种生物标志物在轻度TBI儿童和青少年中的研究之一。
