Blood Biomarkers for Identifying Epidural Hematoma in Patients Presenting with a Glasgow Coma Scale of 13–15: A Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Triage of patients with mild traumatic brain injury (mTBI) and possible isolated epidural hematoma (iEDH) remains a clinical challenge. Blood-based biomarkers are being integrated into mTBI management, but their ability to identify patients with iEDH is uncertain. In this prospective, multicenter cohort study from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study, which recruited between December 19, 2014, and December 17, 2017 (NCT02210221), we included 1,048 mTBI patients (Glasgow Coma Scale ≥ 13) with biomarker sampling and head computed tomography (CT) within 24 h of injury. We assessed six blood-based biomarkers-including glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1)-for their diagnostic performance in identifying patients with mTBI and iEDH. Patients with other traumatic intracranial findings potentially requiring surgery were excluded. Of 1,048 patients (median age 46 years; 64% male), 38 (3.6%) had iEDH and 982 (94%) had negative CT findings. GFAP showed the highest diagnostic accuracy for iEDH (area under the curve 0.77; 95% confidence interval 0.71-0.83) and yielded a negative predictive value of 1.0 at a threshold of 0.19 μg/L. The addition of UCH-L1 did not lead to a significant improvement in diagnostic performance. No significant correlation was found between EDH volume and biomarker levels. In this large multicenter study, GFAP was the only biomarker that could adequately distinguish patients with iEDH from CT-negative cases. These results suggest that GFAP may serve as a tool to rule out iEDH in patients with Glasgow Coma Scale ≥ 13, supporting its use in identifying individuals unlikely to require acute intervention for intracranial injury.
Source: Journal of Neurotrauma
Authors: Katja Malmi, Dana Pisică, Iftakher Hossain, Mehrbod Mohammadian, Thomas van Essen, Teemu M. Luoto, Stefania Mondello, Riikka S.K. Takala, Olli Tenovuo, Thijs Vande Vyvere, Rick Vreeburg, John K. Yue, Andrew I.R. Maas, Kevin K.W. Wang, David K. Menon, Virginia F.J. Newcombe, András Büki, Jussi P. Posti
Institutions: University of Turku, Turku University Hospital, Erasmus MC, University of Cambridge, Addenbrooke's Hospital, Imperial College London, Massachusetts General Hospital, Leiden University Medical Center, Medisch Centrum Haaglanden, Stichting Haaglanden Medisch Centrum, Tampere University Hospital, University of Tampere, University of Messina, University of Antwerp, Antwerp University Hospital, San Francisco General Hospital, University of California, San Francisco, Atlanta VA Health Care System, Atlanta VA Medical Center, Morehouse School of Medicine, Örebro University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Suomen Lääketieteen Säätiö, UK Research and Innovation, National Institute for Health and Care Research, Alzheimer’s Research UK, Sigrid Juséliuksen Säätiö, Orionin Tutkimussäätiö, Paulon Säätiö, Suomen Aivosäätiö, Maire Taposen Säätiö, Suomalainen Lääkäriseura Duodecim, Terveyden Tutkimuksen Toimikunta, National Institute for Health and Care Research Applied Research Collaboration Oxford and Thames Valley
OpenAlex ID: W7140134537