S100B vs. “GFAP and UCH-L1” assays in the management of mTBI patients

Abstract

Abstract Objectives To compare for the first time the performance of “GFAP and UCH-L1” vs. S100B in a cohort of patients managed for mild traumatic brain injury (mTBI) according to actualized French guidelines. Methods A prospective study was recently carried at the Emergency Department of Clermont-Ferrand University Hospital in France. Patients with mTBI presenting a medium risk of complications were enrolled. Blood S100B and “GFAP and UCHL-1” were sampled and measured according to French guidelines. S100B was measured in patients with samples within 3 h of trauma (Cobas®, Roche Diagnostics), while GFAP and UCHL-1 were measured in all patients (samples <3 h and 3–12 h) using another automated assay (i-STAT® Alinity, Abbott). Results For sampling <3 h, serum S100B correctly identifies intracranial lesions with a specificity of 25.7 % (95 % CI; 19.5–32.6 %), a sensitivity of 100 % (95 % CI; 66.4–100 %), and a negative predictive value of 100 % (95 % CI; 92.5–100 %). For sampling <12 h, plasma “GFAP and UCH-L1” levels correctly identify intracranial lesions with a specificity of 31.7 % (95 % CI; 25.7–38.2 %), a sensitivity of 100 % (95 % CI; 73.5–100 %), and a negative predictive value of 100 % (95 % CI; 95–100 %). Comparison of specificities (25.7 vs. 31.7 %) did not reveal a statistically significant difference (p=0.16). Conclusions We highlight the usefulness of measuring plasma “GFAP and UCH-L1” levels to target mTBI patients (sampling within 12 h post-injury) and optimize the reduction of CT scans.