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Summary
Mild head trauma and biomarkers of acute brain injury
Francisco Temboury Ruiz1, Francisco Moya Torrecilla2, Miguel Ángel Arráez Sánchez3, Ignacio Arribas Gómez 4, Agustina Vicente Bártulos5, Francisco José Gallego España6, Miriam Menacho Román7, Audrey Morales Rodríguez8, Daniel Morell-García9, Inés Pecharromán de las Heras10, José Roberto Penedo Alonso11, José Antonio Prieto Arruñada12, Fernando Rosell Ortiz13, Carlos Sánchez Rodríguez14
Affiliation of the authors
1Servicio de Urgencias, Hospital Universitario Virgen de la Victoria, Málaga, Spain. 2Servicios Médicos Internacionales, Hospital Vithas Xanit Internacional, Málaga, Spain. 3Servicio de Neurocirugía, Hospital Regional Universitario Carlos Haya, Málaga, Spain. 4Servicio de Bioquímica Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain. 5Servicio de Radiología de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain. CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. 6Centro de Emergencias Sanitarias 061 Andalucía, Spain. 7Servicio de Bioquímica Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain. 8Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain. 9Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Mallorca, Spain. 10Servicio de Radiodiagnóstico, Sección de Urgencias y Neurorradiología, Hospital Universitario Ramón y Cajal, Madrid, Spain. 11Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain. 12Sistema d'Emergències Mèdiques de Cataluña, Barcelona, Spain. 13Servicio de Emergencias 061 de La Rioja, Logroño, Spain. Centro de Investigación Biomédica de La Rioja. 14Servicio de Asistencia Municipal de Urgencia y Rescate Protección Civil (SAMUR-PC), Madrid, Spain.
DOI
Quote
Temboury Ruiz F, Moya Torrecilla F, Arráez Sánchez MA, Arribas Gómez I, Vicente Bártulos A, Gallego España FJ, Menacho Román M, Morales Rodríguez A, Morell-García D, Pecharromán de las Heras I, Penedo Alonso JR, Prieto Arruñada JA, Rosell Ortiz F, Sánchez Rodríguez C. Mild head trauma and biomarkers of acute brain injury. Rev Esp Urg Emerg. 2024;3:31–6
Summary
Cranial computed tomography (CT) is the standard diagnostic tool for evaluating brain injury in patients with craniocerebral trauma and for identifying patients who should undergo immediate surgery. In spite of the general consensus on using cranial CT in patients with severe or moderate trauma, there is no agreement on whether CT is needed for those with mild injuries (Glasgow
Coma Scale [GCS] scores, 13-15) given the low prevalence of intracranial abnormalities detected by CT and the low associated mortality. Two blood- and plasma-based biomarkers, glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1), are helpful for making decisions about adults with GCS scores between 13 and 15 in the first 12 hours after head injury. These biomarkers can indicate the need for CT or help rule out unnecessary imaging. The negative predictive value of negative findings for GFAP and UCH-L1 within 12 hours of trauma allows CT to be ruled out in patients with GCS 15 scores who have
symptoms and/or risk factors. CT can also be avoided or in patients with GCS scores of 13 or 14. Such patients can be discharged to home observation if they have recovered sufficiently and are asymptomatic. If more than 12 hours have passed since the head injury or if one of the biomarkers is positive, a scan should be obtained and the usual protocols followed in accordance with the CT
findings and clinical picture.
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