Abstract：
OBJECTIVE: Data in literature indicate that in patients suffering a minor head injury (MHI), biomarkers serum levels could be effective to predict the absence of intracranial injury (ICI) on head CT scan. Use of these biomarkers in case of patients taking oral anticoagulants who experience MHI is very limited. We investigated biomarkers as predictors of ICI in anticoagulated patients managed in an ED.
METHODS: We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The outcome was delayed ICI (dICI), defined as ICI on the second CT scan after a first negative CT scan. We assessed the sensitivity (SE), specificity (SP), negative predictive value (NNV) and positive predictive value (PPV) of the biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in order to identify dICI.
RESULTS: Our study population was of 234 patients with a negative first CT scan who underwent a second CT scan. The rate of dICI was 4.7 %. The NPV for the detection of dICI were respectively (IC 95 %): S100B 92.7 % (86.0-96.8 %,); ubiquitin C-terminal hydrolase-L1 (UCH-L1) 91.8 % (83.8-96.6 %); glial fibrillary protein (GFP) 100 % (83.2-100 %); TBI 100 % (66.4-100 %). The AUC for the detection of dICI was 0.407 for S100B, 0.563 for neuron-specific enolase (NSE), 0.510 for UCH-L1 and 0.720 for glial fibrillary acidic protein (GFAP), respectively.
CONCLUSIONS: The NPV of the analyzed biomarkers were high and they potentially could limit the number of head CT scan for detecting dICI in anticoagulated patients suffering MHI. GFAP and Alinity TBI seem to be effective to rule out a dCI, but future trials are needed.
METHODS: We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The outcome was delayed ICI (dICI), defined as ICI on the second CT scan after a first negative CT scan. We assessed the sensitivity (SE), specificity (SP), negative predictive value (NNV) and positive predictive value (PPV) of the biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in order to identify dICI.
RESULTS: Our study population was of 234 patients with a negative first CT scan who underwent a second CT scan. The rate of dICI was 4.7 %. The NPV for the detection of dICI were respectively (IC 95 %): S100B 92.7 % (86.0-96.8 %,); ubiquitin C-terminal hydrolase-L1 (UCH-L1) 91.8 % (83.8-96.6 %); glial fibrillary protein (GFP) 100 % (83.2-100 %); TBI 100 % (66.4-100 %). The AUC for the detection of dICI was 0.407 for S100B, 0.563 for neuron-specific enolase (NSE), 0.510 for UCH-L1 and 0.720 for glial fibrillary acidic protein (GFAP), respectively.
CONCLUSIONS: The NPV of the analyzed biomarkers were high and they potentially could limit the number of head CT scan for detecting dICI in anticoagulated patients suffering MHI. GFAP and Alinity TBI seem to be effective to rule out a dCI, but future trials are needed.
摘要：
目的：文献数据表明，在患有轻微颅脑损伤（MHI）的患者中，血清生物标志物水平可以有效预测头部CT扫描中颅内损伤（ICI）的不存在。这些生物标志物在服用口服抗凝剂的患者经历MHI的情况下的使用非常有限。我们研究了在ED中管理的抗凝患者中作为ICI预测因子的生物标志物。
方法：我们进行了一个单一队列，prospective,ED中的观察性研究。我们的结构化临床路径包括第一次头部CT扫描，24h观察并进行第二次CT扫描。结果是延迟ICI（DICI），定义为在第一次负CT扫描之后的第二次CT扫描上的ICI。我们评估了灵敏度(SE)，特异性（SP），生物标志物S100B的阴性预测值（NNV）和阳性预测值（PPV），NSE,GFAP,UCH-L1和AlinityTBI以鉴定DICI。
结果：我们的研究人群为234例首次CT扫描阴性且接受了第二次CT扫描的患者。dICI的发生率为4.7%。检测dICI的NPV分别为（IC95％）：S100B92.7％（86.0-96.8％，);泛素C端水解酶-L1(UCH-L1)91.8%(83.8-96.6%);胶质原纤维蛋白(GFP)100%(83.2-100%);TBI100%(66.4-100%)。S100B检测dICI的AUC为0.407，0.563用于神经元特异性烯醇化酶(NSE)，UCH-L1为0.510，胶质纤维酸性蛋白（GFAP）为0.720，分别。
结论：所分析的生物标志物的NPV很高，并且它们可能会限制在患有MHI的抗凝患者中检测dICI的头部CT扫描次数。GFAP和AlinityTBI似乎可以有效排除dCI，但需要进一步的试验。
方法：我们进行了一个单一队列，prospective,ED中的观察性研究。我们的结构化临床路径包括第一次头部CT扫描，24h观察并进行第二次CT扫描。结果是延迟ICI（DICI），定义为在第一次负CT扫描之后的第二次CT扫描上的ICI。我们评估了灵敏度(SE)，特异性（SP），生物标志物S100B的阴性预测值（NNV）和阳性预测值（PPV），NSE,GFAP,UCH-L1和AlinityTBI以鉴定DICI。
结果：我们的研究人群为234例首次CT扫描阴性且接受了第二次CT扫描的患者。dICI的发生率为4.7%。检测dICI的NPV分别为（IC95％）：S100B92.7％（86.0-96.8％，);泛素C端水解酶-L1(UCH-L1)91.8%(83.8-96.6%);胶质原纤维蛋白(GFP)100%(83.2-100%);TBI100%(66.4-100%)。S100B检测dICI的AUC为0.407，0.563用于神经元特异性烯醇化酶(NSE)，UCH-L1为0.510，胶质纤维酸性蛋白（GFAP）为0.720，分别。
结论：所分析的生物标志物的NPV很高，并且它们可能会限制在患有MHI的抗凝患者中检测dICI的头部CT扫描次数。GFAP和AlinityTBI似乎可以有效排除dCI，但需要进一步的试验。
