CONGRESS 2023 - Clinical and economic evaluation of the clinical utility of UCH-L1 and GFAP in mild TBI
There are 1.4 million UK ED attendances for head injury every year. Up to 2/3 of these are in adult patients. The severity of head injury associated traumatic brain injury (TBI) is assessed clinically using the Glasgow Coma Score (GCS). The majority of fatal outcomes occur in moderate TBI (GCS 9-12) or severe TBI (GCS=8), which account for only 5% of attenders. The presence of severe TBI is usually clinically clear cut and prompt evaluation using computed tomography (CT) imaging of the brain is performed, followed by hospital admission with further detailed evaluation. This is also often the case where moderate TBI is suspected. There is clearly a need to identify patients that account for the remaining 95% of attenders, with minor or mild head injuries, who will go on to have serious intracranial lesions. In patients with GCS 13-15, however, only 1/10 demonstrate evidence of pathology on CT scan. The measurement of serum biomarkers of brain injury has been proposed as a method to accurately differentiate those patients with GCS 13-15 who are likely to have underlying pathology from those with GCS 13-15 with no underlying pathology. Among the most studied biomarkers are Ubiquitin C-terminal hydroxylase-L1 (UCH-L1) and Glial Fibrillary Acidic Protein (GFAP). UCH-L1 GFAP have been shown to correlate with TBI severity and clinical outcomes. Current evidence indicates that both serum GFAP and UCH-L1 are detectable in serum in less than 1 hour following a mTBI. GFAP and UCH-L1 levels are significantly elevated in patients with TBI with intracranial lesions on computed tomography (CT) and, in patients with mTBI, can distinguish between those with a normal and an abnormal CT scan of the brain. Patients with mild TBI are at low risk of clinically significant brain injury in the absence of raised serum GFAP and UCH-L1 and other associated risk factors. They do not require a CT head scan and may be safely discharged providing there is a safe support system of care. It is anticipated that this could reduce head CT in these patients by 40%. Methodology and preliminary results form an ongoing clinical and economic evaluation of the FDA approved serum GFAP and UCH-L1 on the Abbott Alinity platform in patients with mTBI will be presented.
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There are 1.4 million UK ED attendances for head injury every year. Up to 2/3 of these are in adult patients. The severity of head injury associated traumatic brain injury (TBI) is assessed clinically using the Glasgow Coma Score (GCS). The majority of fatal outcomes occur in moderate TBI (GCS 9-12) or severe TBI (GCS≤8), which account for only 5% of attenders.
The presence of severe TBI is usually clinically clear cut and prompt evaluation using computed tomography (CT) imaging of the brain is performed, followed by hospital admission with further detailed evaluation. This is also often the case where moderate TBI is suspected. There is clearly a need to identify patients that account for the remaining 95% of attenders, with minor or mild head injuries, who will go on to have serious intracranial lesions.
In patients with GCS 13-15, however, only 1/10 demonstrate evidence of pathology on CT scan.
The measurement of serum biomarkers of brain injury has been proposed as a method to accurately differentiate those patients with GCS 13-15 who are likely to have underlying pathology from those with GCS 13-15 with no underlying pathology.
Among the most studied biomarkers are Ubiquitin C-terminal hydroxylase-L1 (UCH-L1) and Glial Fibrillary Acidic Protein (GFAP). UCH-L1 GFAP have been shown to correlate with TBI severity and clinical outcomes. Current evidence indicates that both serum GFAP and UCH-L1 are detectable in serum in less than 1 hour following a mTBI. GFAP and UCH-L1 levels are significantly elevated in patients with TBI with intracranial lesions on computed tomography (CT) and, in patients with mTBI, can distinguish between those with a normal and an abnormal CT scan of the brain.
Patients with mild TBI are at low risk of clinically significant brain injury in the absence of raised serum GFAP and UCH-L1 and other associated risk factors. They do not require a CT head scan and may be safely discharged providing there is a safe support system of care. It is anticipated that this could reduce head CT in these patients by 40%.
Methodology and preliminary results form an ongoing clinical and economic evaluation of the FDA approved serum GFAP and UCH-L1 on the Abbott Alinity platform in patients with mTBI will be presented.