Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic Protein
Glial fibrillary acidic protein (GFAP) has become the most promising biomarker for detecting traumatic abnormalities on head computed tomography (CT) in patients with traumatic brain injury (TBI), but most studies have not addressed the potential added value of combining the biomarker with clinical...
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Mary Ann Liebert
2024-11-01
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| Series: | Neurotrauma Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/neur.2023.0077 |
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| author | Mira Keski-Pukkila Justin E. Karr Jussi P. Posti Ksenia Berghem Anna-Kerttu Kotilainen Kaj Blennow Henrik Zetterberg Grant L. Iverson Teemu M. Luoto |
| author_facet | Mira Keski-Pukkila Justin E. Karr Jussi P. Posti Ksenia Berghem Anna-Kerttu Kotilainen Kaj Blennow Henrik Zetterberg Grant L. Iverson Teemu M. Luoto |
| author_sort | Mira Keski-Pukkila |
| collection | DOAJ |
| description | Glial fibrillary acidic protein (GFAP) has become the most promising biomarker for detecting traumatic abnormalities on head computed tomography (CT) in patients with traumatic brain injury (TBI), but most studies have not addressed the potential added value of combining the biomarker with clinical variables that confer risk for intracranial injuries. The Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries in Adults were the first clinical decision rules in the field with an incorporated biomarker, the S100 astroglial calcium-binding protein B (S100B), which is used in the Mild (Low Risk) group defined by the guidelines. Our aim was to evaluate the performance of the guidelines when S100B was substituted with GFAP. The sample (N = 296) was recruited from the Tampere University Hospital's emergency department between November 2015 and November 2016, and there were 49 patients with available GFAP results who were stratified in the Mild (Low Risk) group (thus patients undergoing biomarker triaging). A previously reported cutoff of plasma GFAP ≥140 pg/mL was used. Within the Mild (Low Risk) group (n = 49), GFAP sensitivity (with 95% confidence intervals in parentheses) for detecting traumatic CT abnormalities was 1.0 (0.40–1.00), specificity 0.34 (0.19–0.53), the negative predictive value (NPV) 1.0 (0.68–1.00), and the positive predictive value (PPV) 0.16 (0.05–0.37). The sensitivity and specificity of the modified guidelines with GFAP, when applied to all imaged patients (n = 197) in the whole sample, were 0.94 (0.77–0.99) and 0.20 (0.15–0.28), respectively. NPV was 0.94 (0.80–0.99) and PPV 0.18 (0.13–0.25). In the Mild (Low Risk) group, none of the patients with GFAP results below 140 pg/mL had traumatic abnormalities on their head CT. These findings were derived from a small patient subgroup. Future researchers should replicate these findings in larger samples and assess whether GFAP has added or comparable value to S100B in acute TBI management. |
| format | Article |
| id | doaj-art-ed7d22f9eaf44cd7a6e7338c5677e59b |
| institution | DOAJ |
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| language | English |
| publishDate | 2024-11-01 |
| publisher | Mary Ann Liebert |
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| series | Neurotrauma Reports |
| spelling | doaj-art-ed7d22f9eaf44cd7a6e7338c5677e59b2025-08-20T02:59:07ZengMary Ann LiebertNeurotrauma Reports2689-288X2024-11-0151506010.1089/neur.2023.0077Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic ProteinMira Keski-Pukkila0Justin E. Karr1Jussi P. Posti2Ksenia Berghem3Anna-Kerttu Kotilainen4Kaj Blennow5Henrik Zetterberg6Grant L. Iverson7Teemu M. Luoto81Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.Department of Psychology, University of Kentucky, Lexington, Kentucky, USA.Neurocenter, Department of Neurosurgery, and Turku Brain Injury Center, Turku University Hospital, and University of Turku, Turku, Finland.Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland.1Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland.Glial fibrillary acidic protein (GFAP) has become the most promising biomarker for detecting traumatic abnormalities on head computed tomography (CT) in patients with traumatic brain injury (TBI), but most studies have not addressed the potential added value of combining the biomarker with clinical variables that confer risk for intracranial injuries. The Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries in Adults were the first clinical decision rules in the field with an incorporated biomarker, the S100 astroglial calcium-binding protein B (S100B), which is used in the Mild (Low Risk) group defined by the guidelines. Our aim was to evaluate the performance of the guidelines when S100B was substituted with GFAP. The sample (N = 296) was recruited from the Tampere University Hospital's emergency department between November 2015 and November 2016, and there were 49 patients with available GFAP results who were stratified in the Mild (Low Risk) group (thus patients undergoing biomarker triaging). A previously reported cutoff of plasma GFAP ≥140 pg/mL was used. Within the Mild (Low Risk) group (n = 49), GFAP sensitivity (with 95% confidence intervals in parentheses) for detecting traumatic CT abnormalities was 1.0 (0.40–1.00), specificity 0.34 (0.19–0.53), the negative predictive value (NPV) 1.0 (0.68–1.00), and the positive predictive value (PPV) 0.16 (0.05–0.37). The sensitivity and specificity of the modified guidelines with GFAP, when applied to all imaged patients (n = 197) in the whole sample, were 0.94 (0.77–0.99) and 0.20 (0.15–0.28), respectively. NPV was 0.94 (0.80–0.99) and PPV 0.18 (0.13–0.25). In the Mild (Low Risk) group, none of the patients with GFAP results below 140 pg/mL had traumatic abnormalities on their head CT. These findings were derived from a small patient subgroup. Future researchers should replicate these findings in larger samples and assess whether GFAP has added or comparable value to S100B in acute TBI management.https://www.liebertpub.com/doi/10.1089/neur.2023.0077computed tomographyemergency treatmentglial fibrillary acidic proteinguidelinetraumatic brain injury |
| spellingShingle | Mira Keski-Pukkila Justin E. Karr Jussi P. Posti Ksenia Berghem Anna-Kerttu Kotilainen Kaj Blennow Henrik Zetterberg Grant L. Iverson Teemu M. Luoto Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic Protein Neurotrauma Reports computed tomography emergency treatment glial fibrillary acidic protein guideline traumatic brain injury |
| title | Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic Protein |
| title_full | Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic Protein |
| title_fullStr | Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic Protein |
| title_full_unstemmed | Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic Protein |
| title_short | Preliminary Evaluation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries with Glial Fibrillary Acidic Protein |
| title_sort | preliminary evaluation of the scandinavian guidelines for initial management of minimal mild and moderate head injuries with glial fibrillary acidic protein |
| topic | computed tomography emergency treatment glial fibrillary acidic protein guideline traumatic brain injury |
| url | https://www.liebertpub.com/doi/10.1089/neur.2023.0077 |
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