Validity and clinical utility of brain injury biomarkers in the assessment and risk stratification of mild traumatic brain injury in emergency departments.

BACKGROUND AND OBJECTIVE: The diagnosis of intracranial injury (ICI) after mild traumatic brain injury (TBI) is made using cranial computed tomography (CT), a technique that involves radiation and waiting times in the emergency department. Serum biomarkers, such as S100β, GFAP, and UCH-L1, could be rapid and efficient alternatives for ruling out ICI.

MATERIALS AND METHODS: This was a cross-sectional observational study evaluating diagnostic tests in adult patients treated in the emergency department between 2023 and 2024 for mild TBI, who underwent cranial CT and serum determination of these biomarkers.

RESULTS: A total of 329 patients with a mean age of 77 years were included, 59.3% of whom were women. 8.4% showed ICI on cranial CT. Sensitivity was 92.9% and negative predictive value was 96.3% in TBI test (GFAP+UCH-L1), higher than that of S100β. Patients with ICI had higher GFAP concentrations.

CONCLUSIONS: TBI test, and more specifically GFAP, showed greater diagnostic performance, supporting its use as a tool to optimize the indication for cranial CT in the emergency department after mild TBI.