|
Citation
|
Bazarian JJ, Welch RD, Caudle K, Jeffrey CA, Chen JY, Chandran R, McCaw T, Datwyler SA, Zhang H, McQuiston B. Acad. Emerg. Med. 2021; ePub(ePub): ePub. |
|
Abstract
|
STUDY OBJECTIVE: To determine the accuracy of a new, rapid blood test combining measurements of both glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) for predicting acute traumatic intracranial injury (TII) on head CT scan after mild traumatic brain injury (mTBI).
METHODS: Analysis of banked venous plasma samples from subjects completing the Prospective Clinical Evaluation of Biomarkers of Traumatic Brain Injury (ALERT-TBI) trial, enrolled 2012-14 at 22 investigational sites in the US and Europe. All subjects were ≥18 years old, presented to an emergency department (ED) with a non-penetrating head injury and Glasgow Coma Scale score (GCS) 9-15 (mild to moderate TBI), underwent head CT scanning as part of their clinical care, and had blood sampling within 12 hours of injury. Plasma concentrations of GFAP and UCH-L1 were measured using i-STAT Alinity and TBI plasma cartridge and compared to acute TII on head CT scan.
RESULTS: Of the 2,011 subjects enrolled in ALERT-TBI, 1,918 had valid CT scans and plasma specimens for testing and 1,901 (99.1%) had GCS 13-15 (mTBI), for which the rapid test was intended. Among these subjects, the rapid test had a sensitivity of 0.958 (95%CI: 0.906, 0.982), specificity of 0.404 (0.382, 0.427), negative predictive value (NPV) of 0.993 (0.985, 0.997), and positive predictive value of 0.098 (0.082, 0.116) for acute TII.
CONCLUSIONS: A rapid i-STAT-based test had high sensitivity for prediction of acute TII, comparable to lab-based platforms. The speed, portability and high accuracy of this test may facilitate clinical adoption of brain biomarker testing as an aid to head CT decision-making in EDs.
Language: en |