Posterior reversible encephalopathy syndrome (PRES) on the second postpartum day: learning experience from a case report and literature review

Posterior reversible encephalopathy syndrome (PRES) on the second postpartum day: learning experience from a case report and literature review

Mild traumatic brain injury, Biomarkers, Head CT scan, Patient treatment turnaround time, Diagnostic
accuracy

Introduction Mild traumatic brain injury (mTBI) represents a major public health concern and affects millions of
people worldwide every year. Diagnosis mainly relies on clinical criteria and computed tomography (CT) scans. GFAP
(glial fibrillary acidic protein) and UCH-L1 (ubiquitin carboxyl-terminal hydrolase-L1) have been recently studied as
potential biomarkers of mTBI. This study retrospectively evaluated the possible use of these combined biomarkers as
negative predictors for excluding brain injuries in patients with suspected mTBI in the emergency department.
Methods Adult patients (n=130) enrolled at Tor Vergata University Hospital (Rome, Italy), consecutively registered
at the triage of the emergency department between October 2022 and January 2023, with non-penetrating TBI and
Glasgow Coma Scale (GCS) score of 13–15, were considered. All eligible patients underwent intracranial CT scans and
blood tests, within 12 h after trauma, for GFAP and UCH-L1 serum concentrations.
Results Intracranial CT detected injuries in only seven patients (5%); GFAP and UCH-L1 tested positive in 96 patients
and negative in 34 patients (74% vs. 26%). Combined biomarkers had a sensitivity equal to 1.00 (95% CI 0.64-1.00) and
a negative predictive value (NPV) of 1.00 (0.99-1.00) in mTBI diagnosis with a negative CT.
Conclusions Combined laboratory tests for GFAP and UCH-L1 biomarkers might play a potential clinical role in
avoiding unnecessary head CT scans after mTBI in emergency departments.
Keywords Mild traumatic brain injury, Biomarkers, Head CT scan, Patient treatment turnaround time, Diagnostic
accuracy

Jacopo M. Legramante1,2†, Marilena Minieri1,3,4*†, Marzia Belli2

, Alfredo Giovannelli4

, Alessia Agnoli4

, Daniela Bajo4
,

Lorenza Bellincampi4

, Anna Maria De Angelis4

, Alessandro Terrinoni3,4, Massimo Pieri3,4, Eleonora Nicolai3
,

Vito N. Di Lecce2

, Carla Paganelli2

, Gianluigi Ferrazza1,2, Susanna Longo1,2, Marco Ciotti4

and Sergio Bernardini3,4

https://doi.org/10.1186/s12245-024-00708-z

2024

Peri Irawan

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