Papa Linda, Mittal Manoj K, Ramirez Jose, Silvestri Salvatore, Giordano Philip, Braga Carolina F, Tan Ciara N, Ameli Neema J, Lopez Marco A, Haeussler Crystal A, Mendez Giordano Diego, Zonfrillo Mark R
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. 2017 Jul 1;34(13):2132-2140. doi: 10.1089/neu.2016.4806. Epub 2017 Apr 18.
This study examined the performance of serum ubiquitin C-terminal hydrolase (UCH-L1) in detecting traumatic intracranial lesions on computed tomography (CT) scan (+CT) in children and youth with mild and moderate TBI (mmTBI) and assessed its performance in trauma control patients without head trauma. This prospective cohort study enrolled children and youth presenting to three level 1 trauma centers after blunt head trauma and a Glasgow Coma Scale (GCS) score of 9-15 as well as trauma control patients with GCS 15 that did not have blunt head trauma. The primary outcome measure was the presence of intracranial lesions on initial CT scan. Blood samples were obtained in all patients within 6 h of injury and measured by enzyme-linked immunosorbent assay ELISA for UCH-L1 (ng/mL). A total of 256 children and youth were enrolled in the study and had serum samples drawn within 6 h of injury for analysis; 196 had blunt head trauma and 60 were trauma controls. CT scan of the head was performed in 151 patients and traumatic intracranial lesions on CT scan were evident in 17 (11%), all of whom had a GCS of 13-15. The area under the receiver operating characteristic curve (AUC) for UCH-L1 in detecting children and youth with traumatic intracranial lesions on CT was 0.83 (95% confidence interval [CI], 0.73-0.93). In those presenting with a GCS of 15, the AUC for detecting lesions was 0.83 (95% CI, 0.72-0.94). Similarly, in children under 5 years of age, the AUC was 0.79 (95% CI, 0.59-1.00). Performance for detecting intracranial lesions at a UCH-L1 cut-off level of 0.18 ng/mL yielded a sensitivity of 100%, a specificity of 47%, and a negative predictive value of 100%. UCH-L1 showed good performance in infants and toddlers younger than 5 years and performed well in children and youth with a GCS score of 15. Before clinical application, further study in larger cohort of children and youth with mild TBI is warranted.
本研究检测了血清泛素C末端水解酶（UCH-L1）在检测轻中度创伤性脑损伤（mmTBI）的儿童和青少年计算机断层扫描（CT）（+CT）上的创伤性颅内病变中的表现，并评估了其在无头部创伤的创伤对照患者中的表现。这项前瞻性队列研究纳入了因钝性头部创伤就诊于三个一级创伤中心且格拉斯哥昏迷量表（GCS）评分为9-15的儿童和青少年，以及GCS评分为15且无钝性头部创伤的创伤对照患者。主要结局指标是初次CT扫描时颅内病变的存在情况。在所有患者受伤后6小时内采集血样，并用酶联免疫吸附测定法（ELISA）检测UCH-L1（ng/mL）。共有256名儿童和青少年参与本研究，并在受伤后6小时内采集血清样本进行分析；196名有钝性头部创伤，60名是创伤对照。151名患者进行了头部CT扫描，其中17名（11%）CT扫描显示有创伤性颅内病变，所有这些患者的GCS评分为13-15。UCH-L1检测CT上有创伤性颅内病变的儿童和青少年的受试者操作特征曲线下面积（AUC）为0.83（95%置信区间[CI]，0.73-0.93）。在GCS评分为15的患者中，检测病变的AUC为0.83（95%CI，0.72-0.94）。同样，在5岁以下儿童中，AUC为0.79（95%CI，0.59-1.00）。当UCH-L1临界值为0.18 ng/mL时，检测颅内病变的敏感度为100%，特异度为47%，阴性预测值为100%。UCH-L1在5岁以下的婴幼儿中表现良好，在GCS评分为15的儿童和青少年中也表现出色。在临床应用之前，有必要在更大的轻度TBI儿童和青少年队列中进行进一步研究。
