Citation

Papa L, Mittal MK, Ramirez J, Silvestri S, Giordano P, Braga CF, Tan CN, Ameli NJ, Lopez M, Haeussler CA, Mendez Giordano D, Zonfrillo MR. J. Neurotrauma 2017; 34(13): 2132-2140.

Affiliation

55 Claverick St 2nd FlProvidence, Rhode Island, United States , 02903 ; zonfrillo@brown.edu.

Copyright

(Copyright © 2017, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2016.4806

PMID

28158951

Abstract

This study examined the performance of serum Ubiquitin C-terminal Hydrolase (UCH-L1) in detecting traumatic intracranial lesions on CT scan (+CT) in children and youth with mild and moderate TBI (MMTBI) and assessed its performance in trauma control patients without head trauma. This prospective cohort study enrolled children and youth presenting to three Level 1 Trauma Centers following blunt head trauma and a GCS 9-15 as well as trauma control patients with GCS 15 that did not have blunt head trauma. The primary outcome measure was the presence of intracranial lesions on initial CT scan. Blood samples were obtained in all patients within six hours of injury and measured by ELISA for UCH-L1 (ng/ml). A total of 256 children and youth were enrolled in the study and had serum samples drawn within 6 hours of injury for analysis, 196 had blunt head trauma and 60 were trauma controls. CT scan of the head was performed in 151 patients and traumatic intracranial lesions on CT scan were evident in 17 (11%), all of whom had a GCS 13-15. The area under the ROC curve (AUC) for UCH-L1 in detecting children and youth with traumatic intracranial lesions on CT was 0.83 (95%CI 0.73-0.93). In those presenting with a GCS of 15, the AUC for detecting lesions was 0.83 (95%CI 0.72-0.94). Similarly, in children under five years old the AUC was 0.79 (95%CI 0.59-1.00). Performance for detecting intracranial lesions at a UCH-L1 cutoff level of 0.18 ng/ml yielded a sensitivity of 100%, a specificity of 47% and negative predictive value of 100%.

CONCLUSIONS: UCH-L1 showed good performance in infants and toddlers younger than five years and performed well in children and youth with GCS score of 15. Before clinical application, further study in larger cohort of children and youth with mild TBI is warranted.

Language: en

Keywords

BIOMARKERS; CLINICAL MANAGEMENT OF CNS INJURY; CT SCANNING; HEAD TRAUMA; PEDIATRIC BRAIN INJURY