GFAP Out-Performs S100 beta in Detecting Traumatic Intracranial Lesions on Computed Tomography in Trauma Patients with Mild Traumatic Brain Injury and Those with Extracranial Lesions



L. Papa; S. Silvestri; G. M. Brophy; P. Giordano; J. L. Falk; C. F. Braga; C. N. Tan; N. J. Ameli; J. A. Demery; N. K. Dixit; M. E. Mendes; R. L. Hayes; K. K. W. Wang;C. S. Robertson


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Abbreviated Journal Title

J. Neurotrauma


computed tomography (CT); fractures; glial fibrillary acidic protein; (GFAP); mild traumatic brain injury/concussion; S100 beta; FIBRILLARY ACIDIC PROTEIN; MINOR HEAD-INJURY; SERUM S100B LEVELS; DECISION-MAKING; BIOMARKERS; DAMAGE; MULTICENTER; S-100B; BLOOD; INDEX; Critical Care Medicine; Clinical Neurology; Neurosciences


Both glial fibrillary acidic protein (GFAP) and S100 beta are found in glial cells and are released into serum following a traumatic brain injury (TBI), however, the clinical utility of S100 beta as a biomarker has been questioned because of its release from bone. This study examined the ability of GFAP and S100 beta to detect intracranial lesions on computed tomography (CT) in trauma patients and also assessed biomarker performance in patients with fractures and extracranial injuries on head CT. This prospective cohort study enrolled a convenience sample of adult trauma patients at a Level I trauma center with and without mild or moderate traumatic brain injury (MMTBI). Serum samples were obtained within 4 h of injury. The primary outcome was the presence of traumatic intracranial lesions on CT scan. There were 397 general trauma patients enrolled: 209 (53%) had a MMTBI and 188 (47%) had trauma without MMTBI. Of the 262 patients with a head CT, 20 (8%) had intracranial lesions. There were 137 (35%) trauma patients who sustained extracranial fractures below the head to the torso and extremities. Levels of S100 beta were significantly higher in patients with fractures, compared with those without fractures (p < 0.001) whether MMTBI was present or not. However, GFAP levels were not significantly affected by the presence of fractures (p > 0.05). The area under the receiver operating characteristics curve (AUC) for predicting intracranial lesions on CT for GFAP was 0.84 (0.73-0.95) and for S100 beta was 0.78 (0.67-0.89). However, in the presence of extracranial fractures, the AUC for GFAP increased to 0.93 (0.86-1.00) and for S100 beta decreased to 0.75 (0.61-0.88). In a general trauma population, GFAP out-performed S100 beta in detecting intracranial CT lesions, particularly in the setting of extracranial fractures.

Journal Title

Journal of Neurotrauma





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