Comparing blood biomarkers to clinical decision rules to select patients suspected of traumatic brain injury for head computed tomography.

Autor:	Li Y; Department of Radiology, Neuroradiology Division, 6429Stanford University, Stanford, CA, USA., Ding VY; Quantitative Sciences Unit, Department of Medicine, 6429Stanford University, Stanford, CA, USA., Chen H; Department of Radiology, Neuroradiology Division, 6429Stanford University, Stanford, CA, USA., Zhu G; Department of Radiology, Neuroradiology Division, 6429Stanford University, Stanford, CA, USA., Jiang B; Department of Radiology, Neuroradiology Division, 6429Stanford University, Stanford, CA, USA., Boothroyd D; Quantitative Sciences Unit, Department of Medicine, 6429Stanford University, Stanford, CA, USA., Rezaii PG; Department of Radiology, Neuroradiology Division, 6429Stanford University, Stanford, CA, USA., Bet AM; Department of Radiology, Neuroradiology Division, 6429Stanford University, Stanford, CA, USA., Paulino AD; 506046Banyan Biomarkers Inc., San Diego, CA, USA., Weber A; 506046Banyan Biomarkers Inc., San Diego, CA, USA., Glushakova OY; Department of Neurosurgery, 6889Virginia Commonwealth University, Richmond, VA, USA., Hayes RL; Department of Neurosurgery, 6889Virginia Commonwealth University, Richmond, VA, USA., Wintermark M; Department of Radiology, Neuroradiology Division, 6429Stanford University, Stanford, CA, USA.
Jazyk:	angličtina
Zdroj:	The neuroradiology journal [Neuroradiol J] 2023 Feb; Vol. 36 (1), pp. 68-75. Date of Electronic Publication: 2022 May 19.
DOI:	10.1177/19714009221101306
Abstrakt:	Introduction: Traumatic brain injury (TBI) is a major public health concern in the U.S. Recommendations for patients admitted in the emergency department (ED) to receive head computed tomography (CT) scan are currently guided by various clinical decision rules. Objective: To compare how a blood biomarker approach compares with clinical decision rules in terms of predicting a positive head CT in adult patients suspected of TBI. Methods: We retrospectively identified patients transported to our emergency department and underwent a noncontrast head CT due to suspicion of TBI and who had blood samples available. Published thresholds for serum and plasma glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1), and serum S100β were used to make CT recommendations. These blood biomarker-based recommendations were compared to those achieved under widely used clinical head CT decision rules (Canadian, New Orleans, NEXUS II, and ACEP Clinical Policy). Results: Our study included 463 patients, of which 122 (26.3%) had one or more abnormalities presenting on head CT. Individual blood biomarkers achieved high negative predictive value (NPV) for abnormal head CT findings (88%-98%), although positive predictive value (PPV) was consistently low (25%-42%). A composite biomarker-based decision rule (GFAP+UCH-L1)'s NPV of 100% and PPV of 29% were comparable or better than those achieved under the clinical decision rules. Conclusion: Blood biomarkers perform at least as well as clinical rules in terms of selecting TBI patients for head CT and may be easier to implement in the clinical setting. A prospective study is necessary to validate this approach.
Databáze:	MEDLINE
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