title: Glial Fibrillary Acidic Protein for Prehospital Diagnosis of Intracerebral Hemorrhage.
abstract: Both, acute ischemic stroke (AIS) and hemorrhage stroke (intracerebral hemorrhage, ICH) require early attention but different treatment strategies. Plasma glial fibrillary acidic protein (GFAP) levels were found to be elevated in ICH patients after they arrived in the hospital. Because treatment options differed, we sought to determine whether GFAP can be used to accurately differentiate between of AIS and ICH in the prehospital setting.
  
  
  
  We assessed acute stroke patients in the Stroke Emergency Mobile (STEMO). STEMO is a stroke ambulance staffed by a specialized team including a neurologist and equipped with a computed tomography scanner plus a point-of-care laboratory. The STEMO ambulance is integrated in the emergency medical system of Berlin, Germany. Following prehospital stroke diagnosis, blood was drawn and subsequently analysed using research assays from Roche diagnostics. The clinical accuracy of plasma GFAP was tested using a cut-off value of 0.29 ng/ml.
  
  
  
  Blood samples of 74 patients were analysed. Twenty-five patients had ICH (mean age 69 ± 11 years, median National Institutes of Health Stroke Scale (NIHSS) 15) and 49 IS (mean age 75 ± 10 years, median NIHSS 6). Nine ICH (0 IS patients) had GFAP-levels above 0.29 ng/ml. The sensitivity and specificity of GFAP for differentiating between ICH and AIS were 36.0 and 100%. The sensitivity for ICH volume >15 ml was 61.5%. ICH patients without GFAP elevation had significantly smaller hemorrhage volumes (median 4.5 vs. 37.6 ml, p = 0.004) and were less likely to deteriorate (19 vs. 56%, p = 0.087).
  
  
  
  GFAP levels >0.29 ng/ml were seen only in ICH, thus confirming the diagnosis of ICH during prehospital care. However, sensitivity is low particularly in smaller hemorrhages.
authors.affiliation: Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Michal
authors.initials: M
authors.lastname: Rozanski
authors.forename: Carolin
authors.initials: C
authors.lastname: Waldschmidt
authors.forename: Alexander
authors.initials: A
authors.lastname: Kunz
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger
authors.forename: Matthias
authors.initials: M
authors.lastname: Wendt
authors.forename: Benjamin
authors.initials: B
authors.lastname: Winter
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bollweg
authors.forename: Kersten
authors.initials: K
authors.lastname: Villringer
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D001604:Berlin; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D019033:Delivery of Health Care, Integrated; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D004632:Emergency Medical Services; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072141:Neurologists; D010348:Patient Care Team; D019095:Point-of-Care Systems; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D020521:Stroke / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein