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This study compared serum glial fibrillary acidic protein (GFAP) and neuronal ubiquitin C-terminal hydrolase (UCH-L1) biomarkers to validated clinical decision rules for detecting intracranial lesions on head CT scans in mild traumatic brain injury patients. In a cohort of 349 patients, the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), and GFAP plus UCH-L1 all had 100% sensitivity for detecting lesions. The CCHR had the highest specificity (33%). Combining GFAP levels with the CCHR yielded the best diagnostic performance. These results suggest that combining biomarkers with clinical decision rules improves diagnostic accuracy in detecting intracranial lesions on CT scans. 

The study evaluated plasma biomarkers—ubiquitin C-terminal hydrolase-L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and S100 calcium-binding protein B (S100B)—in patients with acute traumatic brain injury (TBI). A cohort of 109 adult TBI patients was recruited within 6 hours of injury. In a hyperacute subcohort (20 patients), GFAP and UCH-L1 levels were significantly higher in CT-positive patients. Combining GFAP and UCH-L1 improved diagnostic accuracy for intracranial lesions. These findings highlight their clinical utility in TBI assessment.

Traumatic brain injury (TBI) is common in emergency departments (EDs). Assessing TBI patients is challenging due to confounders, and diagnostics rely on nonspecific signs. European practices vary, especially for discharged patients. This study provides practical recommendations for assessing adult TBI patients, focusing on mild cases not needing hospitalization. A multiprofessional panel based on scientific literature and clinical practices offers consensus recommendations. Key findings include practical clinical assessment, biomarker use, and discharge options. The paper emphasizes GFAP and UCH-L1 biomarkers’ utility in ruling out CT-positive injuries. It also discusses risk factors for prolonged recovery and outlines a stepwise approach for ED assessment and follow-up.

ACEP recruits the field's top experts and thought leaders to develop tools that clinicians can trust and deploy in the clinical setting. The evidence-based, clinical content provided in these tools helps clinicians provide the best possible patient care in the emergency department. Download the ACEP Mobile app to access clinical content and tools for emergency medicine physicians to utilize while providing care in the ED. This tool includes information on the recognition, evaluation and management of mTBI / concussion and other ED relevant topics.

New diagnostic criteria for mild TBI achieved consensus from an international, interdisciplinary expert panel. These diagnostic criteria are designed for use across the lifespan and in civilian trauma, sports, and military settings. As such, they could standardize detection of mild TBI in any context, improving equitable access to clinical care and harmonizing research. As science continues to improve our understanding of mild TBI pathophysiology, clinical presentation, and diagnostic test performance, the diagnostic criteria will need to undergo review and updating.

Although headache is the most common complaint in those with concussion, other symptoms including vestibular, vision, and cognitive are often present and can be overlooked during the medical interview. This webinar recording discusses these symptoms and basic strategies for management.