Ability of serum glial fibrillary acidic protein, ubiquitin C-Terminal Hydrolase-L1, and S100B to differentiate normal and abnormal head computed tomography findings in patients with suspected mild or moderate traumatic brain injury

Robert D. Welch, Syed I. Ayaz, Lawrence M. Lewis, Johan Unden, James Y. Chen, Valerie H. Mika, Ben Saville, Joseph A. Tyndall, Marshall Nash, Andras Buki, Pal Barzo, Dallas Hack, Frank C. Tortella, Kara Schmid, Ronald L. Hayes, Arastoo Vossough, Stephen T. Sweriduk, Jeffrey J. Bazarian

Research output: Contribution to journalArticle

63 Scopus citations

Abstract

Head computed tomography (CT) imaging is still a commonly obtained diagnostic test for patients with minor head injury despite availability of clinical decision rules to guide imaging use and recommendations to reduce radiation exposure resulting from unnecessary imaging. This prospective multicenter observational study of 251 patients with suspected mild to moderate traumatic brain injury (TBI) evaluated three serum biomarkers' (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1] and S100B measured within 6 h of injury) ability to differentiate CT negative and CT positive findings. Of the 251 patients, 60.2% were male and 225 (89.6%) had a presenting Glasgow Coma Scale score of 15. A positive head CT (intracranial injury) was found in 36 (14.3%). UCH-L1 was 100% sensitive and 39% specific at a cutoff value >40 pg/mL. To retain 100% sensitivity, GFAP was 0% specific (cutoff value 0 pg/mL) and S100B had a specificity of only 2% (cutoff value 30 pg/mL). All three biomarkers had similar values for areas under the receiver operator characteristic curve: 0.79 (95% confidence interval; 0.70-0.88) for GFAP, 0.80 (0.71-0.89) for UCH-L1, and 0.75 (0.65-0.85) for S100B. Neither GFAP nor UCH-L1 curve values differed significantly from S100B (p = 0.21 and p = 0.77, respectively). In our patient cohort, UCH-L1 outperformed GFAP and S100B when the goal was to reduce CT use without sacrificing sensitivity. UCH-L1 values <40 pg/mL could potentially have aided in eliminating 83 of the 215 negative CT scans. These results require replication in other studies before the test is used in actual clinical practice.

Original languageEnglish
Pages (from-to)203-214
Number of pages12
JournalJournal of neurotrauma
Volume33
Issue number2
DOIs
StatePublished - Jan 15 2016

Fingerprint Dive into the research topics of 'Ability of serum glial fibrillary acidic protein, ubiquitin C-Terminal Hydrolase-L1, and S100B to differentiate normal and abnormal head computed tomography findings in patients with suspected mild or moderate traumatic brain injury'. Together they form a unique fingerprint.

  • Cite this

    Welch, R. D., Ayaz, S. I., Lewis, L. M., Unden, J., Chen, J. Y., Mika, V. H., Saville, B., Tyndall, J. A., Nash, M., Buki, A., Barzo, P., Hack, D., Tortella, F. C., Schmid, K., Hayes, R. L., Vossough, A., Sweriduk, S. T., & Bazarian, J. J. (2016). Ability of serum glial fibrillary acidic protein, ubiquitin C-Terminal Hydrolase-L1, and S100B to differentiate normal and abnormal head computed tomography findings in patients with suspected mild or moderate traumatic brain injury. Journal of neurotrauma, 33(2), 203-214. https://doi.org/10.1089/neu.2015.4149