The serum biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase (UCH-L1) were found to be effective in detecting concussion in pediatric and adult patients with normal mental status following trauma, according to study results published in BMJ Paediatrics Open. GFAP was more successful than UCH-L1 at detecting concussion; however, UCH-L1 levels were higher in patients with nonconcussive trauma, especially in children.
In a large prospective cohort study, investigators aimed to determine whether GFAP and UCH-L1 concentrations could detect concussion in patients following trauma, and how changes in these concentrations may correlate with concussive and nonconcussive head and body trauma.
Primary outcomes were the presence of concussion and gradients of injury in pediatric vs adult patients. Patients were sorted into 3 groups: patients with concussion, patients with nonconcussive head trauma (control), and patients with nonconcussive body trauma (control).
A total of 751 pediatric and adult patients who had normal mental status within 4 hours of injury were enrolled in the study; 712 had complete biomarker data. Of the enrolled participants, 52% had a concussion, 21% had nonconcussive head trauma, and 27% had nonconcussive body trauma; 25% of participants were children and 75% were adults. Blood samples were repeatedly obtained from adult patients from 4 to 180 hours postinjury.
Within 4 hours of injury, both GFAP and UCH-L1 levels gradually increased for all 3 groups, with the lowest increase seen in patients sustaining nonconcussive trauma and the greatest increase seen in patients with concussion. Compared with both control groups, pediatric and adult patients with concussive injuries were found to have significantly higher GFAP concentrations.
No significant differences in UCH-L1 concentrations were reported between the concussion cohort and head trauma control or between body trauma and head trauma groups.
“Elevations of these biomarkers in non-concussive head trauma suggests possible subconcussive brain injury,” the investigators noted. “GFAP could be potentially useful to detect concussion for up to a week postinjury.”
“The stage is set for future studies to verify these findings,” concluded the authors.
Papa L, Zonfrillo MR, Welch RD, et al. Evaluating glial and neuronal blood biomarkers GFAP and UCH-L1 as gradients of brain injury in concussive, subconcussive and non-concussive trauma: a prospective cohort study. BMJ Paediatr Open. 2019;3:e000473.