Use of plasma-based brain biomarkers in the emergency department to rule out the need for unnecessary head CT imaging in acute mild traumatic brain injury patients.

INTRODUCTION

Computed tomography (CT) is the standard imaging modality for evaluating mild traumatic brain injury (mTBI) in emergency settings. However, most CT scans reveal no intracranial injury, raising concerns about unnecessary radiation exposure, healthcare costs, and diagnostic delays. Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) are promising biomarkers for mTBI assessment. The i-STAT® TBI Plasma cartridge enables rapid assessment of these biomarkers. This study evaluated clinical performance of the TBI Plasma cartridge, focusing on its potential to reduce unnecessary CT utilization and improve diagnostic turnaround times.

METHODS

A single-centre observational study was conducted in an academic emergency department. Adult patients presenting with head trauma and a GCS of 15 were enrolled. TBI biomarker testing was performed and compared to CT findings.

RESULTS

In 141 adult patients, the TBI plasma cartridge demonstrated 100% sensitivity, 34.1% specificity, 6.3% positive predictive value (PPV), and 100% negative predictive value (NPV). Among patients <90 and <65 years old, specificity was 34.6% and 60.7% respectively. In patients with non-elevated biomarkers, CT imaging could have been avoided in 32.6% of patients, saving an estimated 72.8 h. Diagnostic wait time associated with TBI biomarker testing was 14.3 h (4.6%) less than waiting for CT results alone.

CONCLUSION

The TBI plasma cartridge demonstrated excellent sensitivity and NPV in identifying patients without intracranial injury on CT. These findings suggest the potential for the TBI cartridge to efficiently and safely rule-out unnecessary CT imaging and reduce turnaround times for diagnostic test results, which may facilitate improved ED throughput.