Abstract
Objectives
To compare for the first time the performance of “GFAP and UCH-L1” vs. S100B in a cohort of patients managed for mild traumatic brain injury (mTBI) according to actualized French guidelines.
Methods
A prospective study was recently carried at the Emergency Department of Clermont-Ferrand University Hospital in France. Patients with mTBI presenting a medium risk of complications were enrolled. Blood S100B and “GFAP and UCHL-1” were sampled and measured according to French guidelines. S100B was measured in patients with samples within 3 h of trauma (Cobas®, Roche Diagnostics), while GFAP and UCHL-1 were measured in all patients (samples <3 h and 3–12 h) using another automated assay (i-STAT® Alinity, Abbott).
Results
For sampling <3 h, serum S100B correctly identifies intracranial lesions with a specificity of 25.7 % (95 % CI; 19.5–32.6 %), a sensitivity of 100 % (95 % CI; 66.4–100 %), and a negative predictive value of 100 % (95 % CI; 92.5–100 %). For sampling <12 h, plasma “GFAP and UCH-L1” levels correctly identify intracranial lesions with a specificity of 31.7 % (95 % CI; 25.7–38.2 %), a sensitivity of 100 % (95 % CI; 73.5–100 %), and a negative predictive value of 100 % (95 % CI; 95–100 %). Comparison of specificities (25.7 vs. 31.7 %) did not reveal a statistically significant difference (p=0.16).
Conclusions
We highlight the usefulness of measuring plasma “GFAP and UCH-L1” levels to target mTBI patients (sampling within 12 h post-injury) and optimize the reduction of CT scans.
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Research ethics: This research complied with the tenets of the Helsinki Declaration, and has received approval by the French Patient Protection Committee (CPP Ile-de-France X) (Reference 52-2019).
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Informed consent: Patients were informed of their right to express their disagreement regarding the use of their clinical information for research purposes.
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Author contributions: CO and VS analyzed and interpreted the data. CO wrote the initial version of the manuscript. SK helped to proofread the manuscript. VS and DB designed the study and assisted with interpretation of the data and writing of the manuscript. JBBM, FM and JS supervised the trial and data collection. GD, JD and VBD carried out assays. BP provided statistical advice for the study design and analyzed the data. All the authors contributed to revision of the manuscript before submission.
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Competing interests: The authors state no conflict of interest.
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Research funding: None declared.
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Disclosure: The development work on the TBI in vitro diagnostic assay for use in i-STAT handheld analyzers was supported by the US Army Medical Research and Materiel Command under contract n0W81XWH-17-C-0079. The views, opinions and findings contained in this report are those of the authors and should not be constructed as an official Department of the Army position, policy or decision unless so designated by other documentation.
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Data availability: The raw data can be obtained on request from the corresponding author.
References
1. Oris, C, Kahouadji, S, Durif, J, Bouvier, D, Sapin, V. S100B, actor and biomarker of mild traumatic brain injury. Int J Mol Sci 2023;24:6602. https://doi.org/10.3390/ijms24076602.Search in Google Scholar PubMed PubMed Central
2. Jagoda, AS, Bazarian, JJ, Bruns, JJ, Cantrill, SV, Gean, AD, Howard, PK, et al.. Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. J Emerg Nurs 2009;35:e5–40. https://doi.org/10.1016/j.jen.2008.12.010.Search in Google Scholar PubMed
3. Oris, C, Pereira, B, Durif, J, Simon-Pimmel, J, Castellani, C, Manzano, S, et al.. The biomarker S100B and mild traumatic brain injury: a meta-analysis. Pediatrics 2018;141:e20180037. https://doi.org/10.1542/peds.2018-0037.Search in Google Scholar PubMed
4. Sharp, AL, Nagaraj, G, Rippberger, EJ, Shen, E, Swap, CJ, Silver, MA, et al.. Computed tomography use for adults with head injury: describing likely avoidable emergency department imaging based on the Canadian CT head rule. Acad Emerg Med 2017;24:22–30. https://doi.org/10.1111/acem.13061.Search in Google Scholar PubMed
5. Hopman, JH, Santing, JAL, Foks, KA, Verheul, RJ, van der Linden, CM, van den Brand, CL, et al.. Biomarker S100B in plasma a screening tool for mild traumatic brain injury in an emergency department. Brain Inj 2023;37:47–53. https://doi.org/10.1080/02699052.2022.2145360.Search in Google Scholar PubMed
6. Bazarian, JJ, Welch, RD, Caudle, K, Jeffrey, CA, Chen, JY, Chandran, R, et al.. Accuracy of a rapid glial fibrillary acidic protein/ubiquitin carboxyl-terminal hydrolase L1 test for the prediction of intracranial injuries on head computed tomography after mild traumatic brain injury. Acad Emerg Med 2021;28:1308–17. https://doi.org/10.1111/acem.14366.Search in Google Scholar PubMed PubMed Central
7. Harnan, SE, Pickering, A, Pandor, A, Goodacre, SW. Clinical decision rules for adults with minor head injury: a systematic review. J Trauma Inj Infect Crit Care 2011;71:245–51. https://doi.org/10.1097/ta.0b013e31820d090f.Search in Google Scholar PubMed
8. Davis, T, Ings, A. Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults (NICE guideline CG 176). Arch Dis Child Educ Pract Ed 2015;100:97–100. https://doi.org/10.1136/archdischild-2014-306797.Search in Google Scholar PubMed
9. Allouchery, G, Moustafa, F, Roubin, J, Pereira, B, Schmidt, J, Raconnat, J, et al.. Clinical validation of S100B in the management of a mild traumatic brain injury: issues from an interventional cohort of 1449 adult patients. Clin Chem Lab Med 2018;56:1897–904. https://doi.org/10.1515/cclm-2018-0471.Search in Google Scholar PubMed
10. Undén, J, Romner, B. Can low serum levels of S100B predict normal CT findings after minor head injury in adults?: an evidence-based review and meta-analysis. J Head Trauma Rehabil 2010;25:228–40. https://doi.org/10.1097/htr.0b013e3181e57e22.Search in Google Scholar
11. Middleton, J. UCH-L1 and GFAP testing (i-STAT TBI plasma) for the detection of intracranial injury following mild traumatic brain injury. Am Fam Physician 2022;105:313–4.Search in Google Scholar
12. Gil-Jardiné, C, Payen, JF, Bernard, R, Bobbia, X, Bouzat, P, Catoire, P, et al.. Management of patients suffering from mild traumatic brain injury. Anaesth Crit Care Pain Med 2023;42:101260.10.1016/j.accpm.2023.101260Search in Google Scholar PubMed
13. Biberthaler, P, Linsenmeier, U, Pfeifer, KJ, Kroetz, M, Mussack, T, Kanz, KG, et al.. Serum S-100B concentration provides additional information fot the indication of computed tomography in patients after minor head injury: a prospective multicenter study. Shock 2006;25:446–53. https://doi.org/10.1097/01.shk.0000209534.61058.35.Search in Google Scholar PubMed
14. Laribi, S, Kansao, J, Borderie, D, Collet, C, Deschamps, P, Ababsa, R, et al.. S100B blood level measurement to exclude cerebral lesions after minor head injury: the multicenter STIC-S100 French study. Clin Chem Lab Med 2014;52:527–36. https://doi.org/10.1515/cclm-2013-0621.Search in Google Scholar PubMed
15. Undén, L, Calcagnile, O, Undén, J, Reinstrup, P, Bazarian, J. Validation of the Scandinavian guidelines for initial management of minimal, mild and moderate traumatic brain injury in adults. BMC Med 2015;13:292. https://doi.org/10.1186/s12916-015-0533-y.Search in Google Scholar PubMed PubMed Central
16. Papa, L, Brophy, GM, Welch, RD, Lewis, LM, Braga, CF, Tan, CN, et al.. Time course and diagnostic accuracy of glial and neuronal blood biomarkers GFAP and UCH-L1 in a large cohort of trauma patients with and without mild traumatic brain injury. JAMA Neurol 2016;73:551. https://doi.org/10.1001/jamaneurol.2016.0039.Search in Google Scholar PubMed PubMed Central
17. Kahouadji, S, Salamin, P, Praz, L, Coiffier, J, Frochaux, V, Durif, J, et al.. S100B blood level determination for early management of Ski-related mild traumatic brain injury: a pilot study. Front Neurol 2020;11:856. https://doi.org/10.3389/fneur.2020.00856.Search in Google Scholar PubMed PubMed Central
18. Undén, J, Bellner, J, Eneroth, M, Alling, C, Ingebrigtsen, T, Romner, B. Raised serum S100B levels after acute bone fractures without cerebral injury. J Trauma 2005;58:59–61. https://doi.org/10.1097/01.ta.0000130613.35877.75.Search in Google Scholar PubMed
19. Savola, O, Pyhtinen, J, Leino, TK, Siitonen, S, Niemel, O, Hillbom, M. Effects of head and extracranial injuries on serum protein S100B levels in trauma patients. J Trauma Inj Infect Crit Care 2004;56:1229–34. https://doi.org/10.1097/01.ta.0000096644.08735.72.Search in Google Scholar PubMed
20. Papa, L, Zonfrillo, MR, Welch, RD, Lewis, LM, Braga, CF, Tan, CN, et al.. Evaluating glial and neuronal blood biomarkers GFAP and UCH-L1 as gradients of brain injury in concussive, subconcussive and non-concussive trauma: a prospective cohort study. BMJ Paediatr Open 2019;3:e000473. https://doi.org/10.1136/bmjpo-2019-000473.Search in Google Scholar PubMed PubMed Central
21. Papa, L, Silvestri, S, Brophy, GM, Giordano, P, Falk, JL, Braga, CF, et al.. GFAP out-performs S100β in detecting traumatic intracranial lesions on computed tomography in trauma patients with mild traumatic brain injury and those with extracranial lesions. J Neurotrauma 2014;31:1815–22. https://doi.org/10.1089/neu.2013.3245.Search in Google Scholar PubMed PubMed Central
22. Pelinka, LE, Kroepfl, A, Schmidhammer, R, Krenn, M, Buchinger, W, Redl, H, et al.. Glial fibrillary acidic protein in serum after traumatic brain injury and multiple trauma. J Trauma Inj Infect Crit Care 2004;57:1006–12. https://doi.org/10.1097/01.ta.0000108998.48026.c3.Search in Google Scholar PubMed
23. Papa, L, Mittal, MK, Ramirez, J, Ramia, M, Kirby, S, Silvestri, S, et al.. In children and youth with mild and moderate traumatic brain injury, glial fibrillary acidic protein out-performs S100β in detecting traumatic intracranial lesions on computed tomography. J Neurotrauma 2016;33:58–64. https://doi.org/10.1089/neu.2015.3869.Search in Google Scholar PubMed PubMed Central
24. Oris, C, Bouillon-Minois, JB, Pinguet, J, Kahouadji, S, Durif, J, Meslé, V, et al.. Predictive performance of blood S100B in the management of patients over 65 Years old with mild traumatic brain injury. J Gerontol: Ser A 2021;76:1471–9. https://doi.org/10.1093/gerona/glab055.Search in Google Scholar PubMed
25. Haydel, MJ, Blaudeau, E. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000;6.10.1056/NEJM200007133430204Search in Google Scholar PubMed
26. Kahouadji, S, Bouillon-Minois, JB, Oris, C, Durif, J, Pereira, B, Pinguet, J, et al.. Evaluation of serum neurofilament light in the early management of mTBI patients. Clin Chem Lab Med 2022;60:1234–41. https://doi.org/10.1515/cclm-2022-0173.Search in Google Scholar PubMed
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