scholarly journals Study protocol for investigating the performance of an automated blood test measuring GFAP and UCH-L1 in a prospective observational cohort of patients with mild traumatic brain injury: European BRAINI study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043635
Author(s):  
Marion Richard ◽  
Alfonso Lagares ◽  
Victor Bondanese ◽  
Javier de la Cruz ◽  
Odile Mejan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Brain Lesions ◽  
Ct Scans ◽  
Secondary Outcome ◽  
Serum Concentrations ◽  
Brain Ct ◽  
Automated Assay

IntroductionMild traumatic brain injury (mTBI) is a common cause of clinical consultation in the emergency department. Patients with mTBI may undergo brain CT scans based on clinical criteria. However, the proportion of patients with brain lesions on CT is very low. Two serum biomarkers, glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), have been shown to discriminate patients regarding the presence or absence of brain lesions on initial CT scan when assessed within the first 12 hours after TBI. However, the current technique for measuring serum concentrations of GFAP and UCH-L1 is manual and time consuming, which may hinder its use in routine clinical practice. This study assesses the diagnostic accuracy of an automated assay for the measurement of serum GFAP and UCH-L1 in a cohort of patients with mTBI who received a CT scan as the standard of care.Methods and analysisThis is a prospective multicentre observational study of 1760 patients with mTBI recruited in France and Spain across 16 participating sites. Adult patients with an initial Glasgow Coma Scale score of 13–15 and a brain CT scan underwent blood sampling within 12 hours after TBI. The primary outcome measure is the diagnostic performance of an automated assay measuring serum concentrations of GFAP and UCH-L1 for discriminating between patients with positive and negative findings on brain CT-scans. Secondary outcome measures include the performance of these two biomarkers in predicting the neurological status and quality of life at 1 week and 3 months after the trauma.Ethics and disseminationEthics approval was obtained by the Institutional Review Board of Sud-Ouest Outre Mer III in France (Re#2019-A01525-52) and Hospital 12 de Octubre in Spain (Re#19/322). The results will be presented at scientific meetings and published in peer-reviewed publications.Trial registration numberClinicalTrials.gov: NCT04032509.

scholarly journals What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

2021 ◽  
Vol 6 (1) ◽  
pp. e000717
Author(s):  
Panu Teeratakulpisarn ◽  
Phati Angkasith ◽  
Thanakorn Wannakul ◽  
Parichat Tanmit ◽  
Supatcha Prasertcharoensuk ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
High Risk ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Skull Fracture ◽  
Brain Ct ◽  
Baseline Characteristics ◽  
Gcs Score ◽  
The Brain

BackgroundAlthough there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.MethodsThis was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.ResultsThere were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.DiscussionOpen skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.Level of evidenceIII.

scholarly journals Evaluation of Clinical Criteria for Performing Brain CT-Scan in Patients with Mild Traumatic Brain Injury; A New Diagnostic Probe

2019 ◽  
Vol 7 (3) ◽  
pp. 269-277
Author(s):  
Roghieh Molaei-Langroudi ◽  
Ahmad Alizadeh ◽  
Ehsan Kazemnejad-Leili ◽  
Vahid Monsef-Kasmaie ◽  
Seyed-Younes Moshirian
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Clinical Criteria ◽  
Brain Ct ◽  
Diagnostic Probe ◽  
Brain Ct Scan

scholarly journals Findings of brain computed tomography scan in motorcyclist patients with head trauma referred to Shiraz Shahid Rajaei Trauma Center in summer 2016

2021 ◽  
pp. 75-85
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Incidental Findings ◽  
Ct Scans ◽  
Acute Trauma ◽  
Brain Computed Tomography ◽  
Brain Ct ◽  
Brain Ct Scan

Background: Head trauma and subsequent traumatic brain injury are among the main causes of morbidity and mortality in Iran. The present study aimed to assess the abnormal findings of brain computed tomography (CT) scan in motorcyclist patients with traumatic brain injury. Materials and Methods: This retrospective cross-sectional study (July-September 2016) was conducted on all motorcyclist patients over 12 years who were referred for brain CT scan to the Emergency Department of Shahid Rajaei Hospital in Shiraz. Patients' archived medical files were reviewed, and a data collection form including age, gender, and findings related to acute trauma and incidental findings were completed. The obtained data were then statistically analyzed. Results: A total of 642 patients were enrolled. The mean age score of participants was reported as 33.61±17.12 years. All patients were male. A number of 51 (7.9%) patients had abnormal findings in their brain CT scans. The most-reported findings were skull-based (23%) and cranial linear (17%) fractures. No incidental findings (findings unrelated to acute trauma) were found. Moreover, 8 (15.7%) patients died with abnormal findings in their brain CT scans. Conclusion: Since in the present study, only 7.9% of the patients had abnormal findings in their brain CT scan and considering the comparison of the results of this research with those obtained in other similar studies, brain CT scan is highly used in this center.

scholarly journals Incidence of delayed bleeding in patients on antiplatelet therapy after mild traumatic brain injury: a systematic review and meta-analysis

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Giorgio Colombo ◽  
Mattia Bonzi ◽  
Elisa Fiorelli ◽  
Alessandro Jachetti ◽  
Viviana Bozzano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Antiplatelet Therapy ◽  
Mild Traumatic Brain Injury ◽  
Meta Analysis ◽  
Antiplatelet Agent ◽  
Secondary Outcome ◽  
Head Ct

Abstract Background The scientific evidence regarding the risk of delayed intracranial bleeding (DB) after mild traumatic brain injury (MTBI) in patients administered an antiplatelet agent (APA) is scant and incomplete. In addition, no consensus exists on the utility of a routine repeated head computed tomography (CT) scan in these patients. Objective The aim of this study was to evaluate the risk of DB after MTBI in patients administered an APA. Methods A systematic review and meta-analysis of prospective and retrospective observational studies enrolling adult patients with MTBI administered an APA and who had a second CT scan performed or a clinical follow-up to detect any DB after a first negative head CT scan were conducted. The primary outcome was the risk of DB in MTBI patients administered an APA. The secondary outcome was the risk of clinically relevant DB (defined as any DB leading to neurosurgical intervention or death). Results Sixteen studies comprising 2930 patients were included in this meta-analysis. The pooled absolute risk for DB was 0.77% (95% CI 0.23–1.52%), ranging from 0 to 4%, with substantial heterogeneity (I2 = 61%). The pooled incidence of clinically relevant DB was 0.18%. The subgroup of patients on dual antiplatelet therapy (DAPT) had an increased DB risk, compared to the acetylsalicylic acid (ASA)-only patients (2.64% vs. 0.22%; p = 0.04). Conclusion Our systematic review showed a very low risk of DB in MTBI patients on antiplatelet therapy. We believe that such a low rate of DB could not justify routine repeated CT scans in MTBI patients administered a single APA. We speculate that in the case of clinically stable patients, a repeated head CT scan could be useful for select high-risk patients and for patients on DAPT before discharge.

Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Fleur Lorton ◽  
Jeanne Simon-Pimmel ◽  
Damien Masson ◽  
Elise Launay ◽  
Christèle Gras-Le Guen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
University Hospital ◽  
S100b Protein ◽  
Research Network ◽  
Ct Scans ◽  
Intermediate Risk ◽  
Protein Assay ◽  
The Impact

AbstractObjectivesTo evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children.MethodsA before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013–2014) and after (2014–2015) implementation of a modified PECARN rule including the S100B protein assay.ResultsWe included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013–2014 and 568 (53.5%) during 2014–2015. During 2014–2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9–40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013–2014 and 2014–2015. All children with ciTBI were identified by the rules.ConclusionsThe implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.

Evaluating mild traumatic brain injury management at a regional emergency department

2018 ◽  
Vol 24 (5) ◽  
pp. 390-394
Author(s):  
Ashlee Maree Brown ◽  
Dara M Twomey ◽  
Anna Wong Shee
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Best Practice ◽  
Medical Service ◽  
Regional Health ◽  
Diagnosis Codes ◽  
Retrospective Audit ◽  
Concussive Injury

BackgroundEmergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas.AimThe aim of this paper was to assess a regional health service’s adherence to their mTBI CPG.MethodsThis was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation.ResultsFewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources.Discussion/conclusionSeveral key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.

Patients with mild traumatic brain injury: Immediate and long-term outcome compared to intra-cranial injuries on CT scan

Brain Injury ◽  
2006 ◽  
Vol 20 (11) ◽  
pp. 1131-1137 ◽  
Author(s):  
Charlotte Sadowski-Cron ◽  
Jörg Schneider ◽  
Pascal Senn ◽  
Bogdan P. Radanov ◽  
Pietro Ballinari ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals P048: Current practices of management for mild traumatic brain injuries with intracranial hemorrhage

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S80
Author(s):  
É. Fortier ◽  
V. Paquet ◽  
M. Émond ◽  
J. Chauny ◽  
S. Hegg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Intracranial Hemorrhage ◽  
Management Practices ◽  
Brain Injuries ◽  
Quebec City ◽  
Historical Cohort ◽  
Public Sector Health

Introduction: The radiological and clinical follow-up of patients with a mild traumatic brain injury (mTBI) and an intracranial hemorrhage (ICH) is often heterogeneous, as there is no official guideline for CT scan control. Furthermore, public sector health expenditure has increased significantly as the number of MRI and CT scan almost doubled in Canada in the last decade. Therefore, the main objective of this study was to describe the current management practices of mTBI patients with intracranial hemorrhage at two level-1 trauma centers. Methods: Design: An historical cohort was created at the CHU de Québec – Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal). Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation using a standardized checklist. Participants: mTBI patients aged ⩾16 with an ICH were included. Measures: The main and secondary outcomes were the presence of a control CT scan and neurosurgical consultation/admission. Analyses: Univariate descriptive analyses were performed. Inter-observer measures were calculated. Results: Two hundred seventy-four patients were included, of which 51.1% (n = 140) came from a transfer. Mean age was 60.8 and 68.9% (n = 188) were men. Repeat CT scan was performed in 73.6% (n = 201) of our patients as 12.5% showed a clinical deterioration. The following factors might have influenced clinician decision to proceed to a repeat scan: anticoagulation (association of 87.1% with scanning; n = 27), antiplatelet (84.1%; 58), GCS of 13 (94.1%; 16), GCS of 14 (75%; 72) and GCS of 15 (70.2%; 111). 93.0% (n = 254) of patients had a neurosurgical consultation and only 6.7% (17) underwent a neurosurgical intervention. Conclusion: The management of mild traumatic brain injury with hemorrhage uses a lot of resources that might be disproportionate with regards to risks. Further research to identify predictive factors of deterioration is needed.

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