In Children and Youth with Mild and Moderate Traumatic Brain Injury, Glial Fibrillary Acidic Protein Out-Performs S100β in Detecting Traumatic Intracranial Lesions on Computed Tomography.
In adults, glial fibrillary acidic protein (GFAP) has been shown to out-perform S100β in detecting intracranial lesions on computed tomography (CT) in mild traumatic brain injury (TBI). This study examined the ability of GFAP and S100β to detect intracranial lesions on CT in children and youth involved in trauma. This prospective cohort study enrolled a convenience sample of children and youth at two pediatric and one adult Level 1 trauma centers following trauma, including both those with and without head trauma. Serum samples were obtained within 6 h of injury. The primary outcome was the presence of traumatic intracranial lesions on CT scan. There were 155 pediatric trauma patients enrolled, 114 (74%) had head trauma and 41 (26%) had no head trauma. Out of the 92 patients who had a head CT, eight (9%) had intracranial lesions. The area under the receiver operating characteristic curve (AUC) for distinguishing head trauma from no head trauma for GFAP was 0.84 (0.77-0.91) and for S100β was 0.64 (0.55-0.74; p<0.001). Similarly, the AUC for predicting intracranial lesions on CT for GFAP was 0.85 (0.72-0.98) versus 0.67 (0.50-0.85) for S100β (p=0.013). Additionally, we assessed the performance of GFAP and S100β in predicting intracranial lesions in children ages 10 years or younger and found the AUC for GFAP was 0.96 (95% confidence interval [CI] 0.86-1.00) and for S100β was 0.72 (0.36-1.00). In children younger than 5 years old, the AUC for GFAP was 1.00 (95% CI 0.99-1.00) and for S100β 0.62 (0.15-1.00). In this population with mild TBI, GFAP out-performed S100β in detecting head trauma and predicting intracranial lesions on head CT. This study is among the first published to date to prospectively compare these two biomarkers in children and youth with mild TBI.
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.|2 Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children , Orlando, Florida.
Linda
L
Papa
3 Division of Emergency Medicine, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.|4 Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
Manoj K
MK
Mittal
2 Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children , Orlando, Florida.
Jose
J
Ramirez
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.
Michelle
M
Ramia
3 Division of Emergency Medicine, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
Sara
S
Kirby
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.|2 Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children , Orlando, Florida.
Salvatore
S
Silvestri
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.|2 Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children , Orlando, Florida.
Philip
P
Giordano
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.|2 Department of Pediatric Emergency Medicine, Arnold Palmer Hospital for Children , Orlando, Florida.
Kurt
K
Weber
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.
Carolina F
CF
Braga
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.
Ciara N
CN
Tan
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.
Neema J
NJ
Ameli
1 Department of Emergency Medicine, Orlando Regional Medical Center , Orlando, Florida.
Marco
M
Lopez
3 Division of Emergency Medicine, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.|4 Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
Mark
M
Zonfrillo
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood* / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D055815:Young Adult
D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D064568:S100 Calcium Binding Protein beta Subunit
S100B; computed tomography (CT); glial fibrillary acidic protein (GFAP); head trauma; mild traumatic brain injury