title: Elevated levels of serum glial fibrillary acidic protein breakdown products in mild and moderate traumatic brain injury are associated with intracranial lesions and neurosurgical intervention.
abstract: OBJECTIVE
  This study examines whether serum levels of glial fibrillary acidic protein breakdown products (GFAP-BDP) are elevated in patients with mild and moderate traumatic brain injury compared with controls and whether they are associated with traumatic intracranial lesions on computed tomography (CT) scan (positive CT result) and with having a neurosurgical intervention.
  
  
  METHODS
  This prospective cohort study enrolled adult patients presenting to 3 Level I trauma centers after blunt head trauma with loss of consciousness, amnesia, or disorientation and a Glasgow Coma Scale (GCS) score of 9 to 15. Control groups included normal uninjured controls and trauma controls presenting to the emergency department with orthopedic injuries or a motor vehicle crash without traumatic brain injury. Blood samples were obtained in all patients within 4 hours of injury and measured by enzyme-linked immunosorbent assay for GFAP-BDP (nanograms/milliliter).
  
  
  RESULTS
  Of the 307 patients enrolled, 108 were patients with traumatic brain injury (97 with GCS score 13 to 15 and 11 with GCS score 9 to 12) and 199 were controls (176 normal controls and 16 motor vehicle crash controls and 7 orthopedic controls). Receiver operating characteristic curves demonstrated that early GFAP-BDP levels were able to distinguish patients with traumatic brain injury from uninjured controls with an area under the curve of 0.90 (95% confidence interval [CI] 0.86 to 0.94) and differentiated traumatic brain injury with a GCS score of 15 with an area under the curve of 0.88 (95% CI 0.82 to 0.93). Thirty-two patients with traumatic brain injury (30%) had lesions on CT. The area under these curves for discriminating patients with CT lesions versus those without CT lesions was 0.79 (95% CI 0.69 to 0.89). Moreover, the receiver operating characteristic curve for distinguishing neurosurgical intervention from no neurosurgical intervention yielded an area under the curve of 0.87 (95% CI 0.77 to 0.96).
  
  
  CONCLUSIONS
  GFAP-BDP is detectable in serum within an hour of injury and is associated with measures of injury severity, including the GCS score, CT lesions, and neurosurgical intervention. Further study is required to validate these findings before clinical application.
authors: Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA. lpstat@aol.com
authors: Linda
authors: L
authors: Papa
authors: Lawrence M
authors: LM
authors: Lewis
authors: Jay L
authors: JL
authors: Falk
authors: Zhiqun
authors: Z
authors: Zhang
authors: Salvatore
authors: S
authors: Silvestri
authors: Philip
authors: P
authors: Giordano
authors: Gretchen M
authors: GM
authors: Brophy
authors: Jason A
authors: JA
authors: Demery
authors: Neha K
authors: NK
authors: Dixit
authors: Ian
authors: I
authors: Ferguson
authors: Ming Cheng
authors: MC
authors: Liu
authors: Jixiang
authors: J
authors: Mo
authors: Linnet
authors: L
authors: Akinyi
authors: Kara
authors: K
authors: Schmid
authors: Stefania
authors: S
authors: Mondello
authors: Claudia S
authors: CS
authors: Robertson
authors: Frank C
authors: FC
authors: Tortella
authors: Ronald L
authors: RL
authors: Hayes
authors: Kevin K W
authors: KK
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000097:blood* / Q000473:pathology / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D015600:Glasgow Coma Scale; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D014193:Trauma Centers; D055815:Young Adult
chemical_list: D005904:Glial Fibrillary Acidic Protein