血液生物标志物作为急诊科轻度创伤性脑损伤管理中计算机断层扫描的优化工具:一项系统综述。

Blood Biomarkers as Optimization Tools for Computed Tomography in Mild Traumatic Brain Injury Management in Emergency Departments: A Systematic Review.

作者信息

Caballero Ballesteros Ángela, Alonso Gallardo María Isabel, Mora-Delgado Juan

机构信息

Department of Medicine, University of Cádiz, INiBICA, 11003 Cádiz, Spain.

Emergency Department, Hospital Universitario Nuestra Señora de Valme, Ctra. de Cádiz Km. 548,9, 41014 Sevilla, Spain.

出版信息

J Pers Med. 2025 Aug 3;15(8):350. doi: 10.3390/jpm15080350.

Abstract

Traumatic brain injury (TBI), especially mild TBI (mTBI), is frequently caused by traffic accidents, falls, or sports injuries. Although computed tomography (CT) is the gold standard for diagnosis, overuse can lead to unnecessary radiation exposure, increased healthcare costs, and emergency department saturation. Blood-based biomarkers have emerged as potential tools to optimize CT scan use. This systematic review aims to evaluate recent evidence on the role of specific blood biomarkers in guiding CT decisions in patients with mTBI. : A systematic search was conducted in the PubMed, Cochrane, and CINAHL databases for studies published between 2020 and 2024. Inclusion criteria focused on adult patients with mTBI evaluated using both CT imaging and at least one of the following biomarkers: glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein B (S100B). After screening, six studies were included in the final review. : All included studies reported high sensitivity and negative predictive value for the selected biomarkers in detecting clinically relevant intracranial lesions. GFAP and UCH-L1, particularly in combination, consistently identified low-risk patients who could potentially forgo CT scans. While S100B also showed high sensitivity, discrepancies in cutoff values across studies highlighted the need for harmonization. : Blood biomarkers such as GFAP, UCH-L1, and S100B demonstrate strong potential to reduce unnecessary CT imaging in mTBI by identifying patients at low risk of significant brain injury. Future research should focus on standardizing biomarker thresholds and validating protocols to support their integration into clinical practice guidelines.

摘要

创伤性脑损伤(TBI),尤其是轻度创伤性脑损伤(mTBI),常由交通事故、跌倒或运动损伤引起。尽管计算机断层扫描(CT)是诊断的金标准,但过度使用会导致不必要的辐射暴露、医疗成本增加以及急诊科饱和。基于血液的生物标志物已成为优化CT扫描使用的潜在工具。本系统评价旨在评估近期关于特定血液生物标志物在指导mTBI患者CT决策中作用的证据。:在PubMed、Cochrane和CINAHL数据库中进行了系统检索,以查找2020年至2024年发表的研究。纳入标准侧重于使用CT成像和以下至少一种生物标志物评估的成年mTBI患者:胶质纤维酸性蛋白(GFAP)、泛素羧基末端水解酶L1(UCH-L1)和S100钙结合蛋白B(S100B)。筛选后,六项研究纳入最终评价。:所有纳入研究均报告了所选生物标志物在检测临床相关颅内病变方面的高敏感性和阴性预测值。GFAP和UCH-L1,特别是联合使用时,一致识别出可能无需进行CT扫描的低风险患者。虽然S100B也显示出高敏感性,但各研究中临界值的差异突出了统一标准的必要性。:GFAP、UCH-L1和S100B等血液生物标志物通过识别脑损伤风险较低的患者,在减少mTBI患者不必要的CT成像方面显示出强大潜力。未来研究应专注于标准化生物标志物阈值并验证方案,以支持将其纳入临床实践指南。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dbbd/12387816/33deb8217ac1/jpm-15-00350-g001.jpg

相似文献

本文引用的文献

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索