Legramante Jacopo M, Minieri Marilena, Belli Marzia, Giovannelli Alfredo, Agnoli Alessia, Bajo Daniela, Bellincampi Lorenza, De Angelis Anna Maria, Terrinoni Alessandro, Pieri Massimo, Nicolai Eleonora, Di Lecce Vito N, Paganelli Carla, Ferrazza Gianluigi, Longo Susanna, Ciotti Marco, Bernardini Sergio
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Department of Emergency, University Hospital Tor Vergata, Rome, Italy.
Int J Emerg Med. 2024 Oct 24;17(1):164. doi: 10.1186/s12245-024-00708-z.
Mild traumatic brain injury (mTBI) represents a major public health concern and affects millions of people worldwide every year. Diagnosis mainly relies on clinical criteria and computed tomography (CT) scans. GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin carboxyl-terminal hydrolase-L1) have been recently studied as potential biomarkers of mTBI. This study retrospectively evaluated the possible use of these combined biomarkers as negative predictors for excluding brain injuries in patients with suspected mTBI in the emergency department.
Adult patients (n = 130) enrolled at Tor Vergata University Hospital (Rome, Italy), consecutively registered at the triage of the emergency department between October 2022 and January 2023, with non-penetrating TBI and Glasgow Coma Scale (GCS) score of 13-15, were considered. All eligible patients underwent intracranial CT scans and blood tests, within 12 h after trauma, for GFAP and UCH-L1 serum concentrations.
Intracranial CT detected injuries in only seven patients (5%); GFAP and UCH-L1 tested positive in 96 patients and negative in 34 patients (74% vs. 26%). Combined biomarkers had a sensitivity equal to 1.00 (95% CI 0.64-1.00) and a negative predictive value (NPV) of 1.00 (0.99-1.00) in mTBI diagnosis with a negative CT.
Combined laboratory tests for GFAP and UCH-L1 biomarkers might play a potential clinical role in avoiding unnecessary head CT scans after mTBI in emergency departments.
轻度创伤性脑损伤（mTBI）是一个重大的公共卫生问题，每年影响着全球数百万人。诊断主要依靠临床标准和计算机断层扫描（CT）。胶质纤维酸性蛋白（GFAP）和泛素羧基末端水解酶-L1（UCH-L1）最近被作为mTBI的潜在生物标志物进行研究。本研究回顾性评估了这些联合生物标志物作为排除急诊科疑似mTBI患者脑损伤的阴性预测指标的可能性。
纳入了在意大利罗马托雷·韦尔加塔大学医院登记的成年患者（n = 130），这些患者在2022年10月至2023年1月期间在急诊科分诊时连续登记，患有非穿透性TBI且格拉斯哥昏迷量表（GCS）评分为13 - 15分。所有符合条件的患者在创伤后12小时内接受了颅内CT扫描和血液检测，以测定GFAP和UCH-L1的血清浓度。
颅内CT仅在7名患者（5%）中检测到损伤；GFAP和UCH-L1检测结果为阳性的有96名患者，阴性的有34名患者（74%对26%）。在CT结果为阴性的mTBI诊断中，联合生物标志物的敏感性为1.00（95%可信区间0.64 - 1.00），阴性预测值（NPV）为1.00（0.99 - 1.00）。
GFAP和UCH-L1生物标志物的联合实验室检测可能在急诊科避免mTBI后不必要的头部CT扫描方面发挥潜在的临床作用。
