A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Blood Biomarkers for Identifying Epidural Hematoma in Patients Presenting with a Glasgow Coma Scale of 13-15: A Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study
Tekijät: Malmi, Katja; Pisica, Dana; Hossain, Iftakher; Mohammadian, Mehrbod; van Essen, Thomas; Luoto, Teemu M.; Mondello, Stefania; Takala, Riikka S. K.; Tenovuo, Olli; Vande Vyvere, Thijs; Vreeburg, Rick; Yue, John K.; Maas, Andrew I. R.; Wang, Kevin K. W.; Menon, David K.; Newcombe, Virginia F. J.; Buki, Andras; Posti, Jussi P.; CENTER-TBI Investigators and Participants
Kustantaja: Mary Ann Liebert
Julkaisuvuosi: 2026
Lehti: Journal of Neurotrauma
ISSN: 0897-7151
eISSN: 1557-9042
DOI: https://doi.org/10.1177/08977151261430239
Julkaisun avoimuus kirjaamishetkellä: Ei avoimesti saatavilla
Julkaisukanavan avoimuus : Osittain avoin julkaisukanava
Verkko-osoite: https://doi.org/10.1177/08977151261430239
Triage of patients with mild traumatic brain injury (mTBI) and possible isolated epidural hematoma (iEDH) remains a clinical challenge. Blood-based biomarkers are being integrated into mTBI management, but their ability to identify patients with iEDH is uncertain. In this prospective, multicenter cohort study from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study, which recruited between December 19, 2014, and December 17, 2017 (NCT02210221), we included 1,048 mTBI patients (Glasgow Coma Scale ≥ 13) with biomarker sampling and head computed tomography (CT) within 24 h of injury. We assessed six blood-based biomarkers—including glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1)—for their diagnostic performance in identifying patients with mTBI and iEDH. Patients with other traumatic intracranial findings potentially requiring surgery were excluded. Of 1,048 patients (median age 46 years; 64% male), 38 (3.6%) had iEDH and 982 (94%) had negative CT findings. GFAP showed the highest diagnostic accuracy for iEDH (area under the curve 0.77; 95% confidence interval 0.71–0.83) and yielded a negative predictive value of 1.0 at a threshold of 0.19 μg/L. The addition of UCH-L1 did not lead to a significant improvement in diagnostic performance. No significant correlation was found between EDH volume and biomarker levels. In this large multicenter study, GFAP was the only biomarker that could adequately distinguish patients with iEDH from CT-negative cases. These results suggest that GFAP may serve as a tool to rule out iEDH in patients with Glasgow Coma Scale ≥ 13, supporting its use in identifying individuals unlikely to require acute intervention for intracranial injury.
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The research leading to these results was supported by the European Union’s Seventh Framework Programme (FP7/2007–2013) under grant agreement 602150 (CENTER-TBI). I.H. is supported by the Finnish Medical Foundation, the State Research Funding (VTR) of Finland, the Päivikki and Sakari Sohlberg Foundation, the Paulo Foundation, and the Orion Foundation. J.P.P. is supported by the Research Council of Finland and Sigrid Jusélius Foundation, and State Research Funding (VTR) of Finland. T.M.L. has accepted research grants from the Finnish Brain Foundation sr, the Emil Aaltonen Foundation sr, the Maire Taponen Foundation, the Science Fund of the City of Tampere, the Finnish Medical Society Duodecim, and the Research Council of Finland. D.K.M. is supported by the National Institute for Health and Care Research (NIHR, UK) through the Cambridge NIHR Biomedical Research Centre, and by the TBI-REPORTER Project, which is supported by a multifunder consortium consisting of: UK Research and Innovation, National institute for Health and Care Research; UK Department of Health and Social Care; UK Ministry of Defence; and Alzheimer’s Research UK. V.F.J.N. is supported by a National Institute for Health Research (NIHR) Rosetrees Trust Advanced Fellowship, NIHR302544, funded in partnership by the NIHR and Rosetrees Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article. The views expressed are those of the author(s) and not necessarily those of the above-mentioned funders.
