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06 Dec 2018
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Blood test predicts intracranial injuries after trauma

Jackey Suen
06 Aug 2018

Ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may emerge as biomarkers for detecting intracranial injuries after a trauma, a recent prospective study suggests.

The study results also support the clinical use of UCH-L1 and GFAP test to rule out the need for head CT scan in patients presenting with traumatic brain injury (TBI) at emergency departments. [Lancet 2018, doi: 10.1016/S1474-4422(18)30231-X]

Detection of intracranial injuries relies on head CT scan, which is overused and resource intensive. There are also health concerns with regards to the high radiation dose with head CT scans.

In the present study, a group of researchers from Germany, Hungary and the US enrolled 1,977 patients presenting to emergency departments with suspected, non-penetrating TBI. These patients also had a Glasgow Coma Scale score of 9–15, and had undergone head CT scan and blood collection for UCH-L1 and GFAP test within 12 hours after the injury.

Among 1,959 patients with analysable data, 6 percent had CT-detected intracranial injuries. A total of 66 percent of the patients had positive UCH-L1 and GFAP test results.

UCH-L1 and GFAP test had a sensitivity of 0.976 (95 percent confidence interval [CI], 0.931 to 0.995) and a negative predictive value (NPV) of 0.996 (95 percent CI, 0.987 to 0.999) for detection of intracranial injury. Only three of 1,959 patients had false-negative results. The test had a specificity and positive predictive value of 0.364 and 0.095, respectively.

“The results support the routine use of the UCH-L1 and GFAP test in emergency departments to rule out unnecessary head CT scans with a very low false-negative rate,” the investigators suggested.  

“Notably, the majority of patients presenting with mild TBI like concussion do not have visible intracranial injuries on CT scans. As UCH-L1 and GFAP biomarker test requires only blood collection and is reliable in predicting the absence of intracranial injuries, we are hopeful of its future role in ruling out the need for CT scans in these patients,” said investigator Dr Peter Biberthaler of the Technical University of Munich, Germany.

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Most Read Articles
06 Dec 2018
A strong belief in the necessity of medication is associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy correlates with poor adherence, in a diverse cohort of patients with rheumatoid arthritis (RA), suggests a study.
Pearl Toh, Yesterday
First-line therapy with the BTK* inhibitor ibrutinib plus the anti-CD20 immunotherapy rituximab confers significant survival advantage over the current gold-standard regimen of fludarabine, cyclophosphamide, and rituximab (FCR) for young, fit patients with treatment-naïve chronic lymphocytic leukaemia (CLL), according to the E1912 trial, a large cooperative group study supported by the US National Cancer Institute.
6 days ago
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4 days ago
Percutaneous coronary intervention (PCI) displays comparable rates of mortality and serious composite outcomes but a higher rate of target-vessel revascularization at 10 years relative to coronary artery bypass grafting (CABG) in patients with significant left main coronary artery (LMCA) disease, reports a study. On the other hand, CABG delivers lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years.