Citation

Anderson T, Hwang J, Munar M, Papa L, Hinson HE, Vaughan A, Rowell SE. J. Trauma Acute Care Surg. 2020; ePub(ePub): ePub.

Affiliation

Oregon Health & Science University University of Washington Oregon State University Orlando Regional Medical Center Oregon Health & Science University Duke University Medical Center Duke University Medical Center; Oregon Health & Science University.

Copyright

(Copyright © 2020, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002706

PMID

32251265

Abstract

BACKGROUND: Early identification of traumatic intracranial hemorrhage (ICH) has implications for triage and intervention. Blood-based biomarkers were recently FDA approved for prediction of ICH in patients with mild TBI. We sought to determine if biomarkers measured early after injury improve prediction of mortality and clinical/radiologic outcomes compared to GCS alone in patients with moderate or severe TBI (MS-TBI).

METHODS: We measured glial-fibrillary-acidic-protein (GFAP), ubiquitin-C-terminal-hydrolase-L1 (UCH-L1), and microtubule-associated-protein-2 (MAP-2) on arrival to the ED in patients with blunt TBI enrolled in the placebo arm of the Prehospital TXA for TBI Trial (prehospital GCS 3-12, SPB > 90). Biomarkers were modeled individually and together with prehospital predictor variables [PH] (GCS, age, gender). Data was divided into a training dataset and test dataset for model derivation and evaluation. Models were evaluated for prediction of ICH, mass lesion, 48-hour and 28-day mortality, and 6-month Glasgow Outcome Scale-Extended [GOSE] and Disability Rating Scale [DRS]. AUC was evaluated in test data for PH alone, PH+individual biomarkers, and PH+3 biomarkers.

RESULTS: Of 243 patients with baseline samples (obtained a median 84 min after injury), prehospital GCS was 8 (IQR 5,10), 55% had ICH, and 48-hr and 28-day mortality was 7 and 13%. Poor neurologic outcome at 6 months was observed in 34% based on GOS-E ≤4, and 24% based on DRS >7. Addition of each biomarker to PH improved AUC in the majority of predictive models. GFAP+PH compared to PH alone significantly improved AUC in all models [ICH: 0.82 vs 0.64; 48-hour mortality 0.84 vs 0.71; 28-day mortality: 0.84 vs 0.66; GOSE: 0.78 vs 0.69; DRS 0.84 vs 0.81, all p<0.001].

CONCLUSIONS: Circulating blood-based biomarkers may improve prediction neurological outcomes and mortality in patients with MS-TBI over prehospital characteristics alone. GFAP appears to be the most promising. Future evaluation in the prehospital setting is warranted. LEVEL OF EVIDENCE: Prognostic and Epidemiological Level II, Prospective.

Language: en