Summary
Implementation of a protocol for emergency department use of biomarkers when managing the diagnosis of mild traumatic brain injury
Affiliation of the authors
DOI
Quote
González Romero PM, Martín Fernández de Basoa MC, Concepción Masip MT. Implementation of a protocol for emergency department use of biomarkers when managing the diagnosis of mild traumatic brain injury. Rev Esp Urg Emerg. 2024;3:236–9
Summary
BACKGROUND. Glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) can be useful biomarkers during emergency department (ED) evaluation of patients with traumatic brain injury (TBI), helping to reduce the use of cranial computed tomography (cCT) while also shortening ED stays.
MATERIAL AND METHODS. Retrospective observational study of a convenience sample of patients over the age of 18 years attended in a hospital ED within 12 hours of a mild TBI between December 2022 and February 2024. We studied cases in which GFAP and UCH-L1 analyses had been ordered. Patients with TBI who were attended in the same hospital between October 2021 and October 2022, a period when we did not test for the biomarkers, served as a comparison group.
RESULTS. Of 321 tests performed in patients diagnosed with TBI during the study period, 214 were positive for the biomarkers. Of 199 cCT scans ordered, 86.43% were normal. Scans were not ordered for 92 patients (28.67%) with TBI. The sensitivity and negative predictive value of the biomarker results were both 100%. Among patients with negative cCT findings, the mean (SD) stay in the ED was shorter for patients with negative biomarker results (3 h and 27 min [3 h and 32 min]) than for those with positive results (4 h 53
min [10h 18 min]).
CONCLUSIONS. The TBI biomarkers GFAP and UCH-L1 used in combination are excellent for ruling out brain lesions in patients with mild injuries evaluated within 24 hours. A protocol for using these biomarkers improved the efficiency of ED care and reduced radiation exposure, while optimizing resource use.