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  • 358 The relationship between serum biomarkers of traumatic brain injury (TBI) and magnetic resonance imaging (MRI) in patients discharged from the emergency department (ED) with a normal acute CT

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RCEM abstracts 2020
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358 The relationship between serum biomarkers of traumatic brain injury (TBI) and magnetic resonance imaging (MRI) in patients discharged from the emergency department (ED) with a normal acute CT
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  1. Daniel Whitehouse1,
  2. Sophie Richter2,
  3. Endre Czeiter3,
  4. Stefan Winzeck2,
  5. Evgenios N Kornaropoulos2,
  6. Tilak Das2,
  7. Thijs Vande Vyvere4,
  8. Jan Verheyden5,
  9. Guy B Williams6,
  10. Marta M Correia7,
  11. Kevin Wang8,
  12. David K Menon2,
  13. András Büki9,
  14. Virginia FJ Newcombe1,
  15. CENTER-TBI MRI Sub-Study Participants and Investigators10
  1. 1University of Cambridge, University Division of Anaesthesia
  2. 2Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
  3. 31 – Department of Neurosurgery, Medical School, University of Pécs 2 – Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs 3 – MTA-PTE Clinical Neuroscience MR Research Group
  4. 41 – Research and Development, Icometrix, Kolonel Begaultlaan 1b/12, 3012 Leuven, Belgium 2- Department of Radiology, Antwerp University Hospital and University of Antwerp
  5. 5Research and Development, Icometrix, Kolonel Begaultlaan 1b/12, 3012 Leuven, Belgium
  6. 6Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge
  7. 7MRC Cognition and Brain Sciences Unit, University of Cambridge
  8. 81-Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute 2-Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center (VAMC
  9. 91-Department of Neurosurgery, Medical School, University of Pécs 2-Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs
  10. 10CENTER-TBI MRI Sub-Study Participants and Investigators

Abstract

Aims/Objectives/Background CT remains the neuroimaging of choice in patients with TBI, however the relative lack of sensitivity as compared to MRI for certain traumatic lesion types, including diffuse axonal injury (DAI), could lead to missing important intracranial findings.1 Serum biomarkers may allow screening of ED patients, highlighting those who will benefit from MRI and offer a pathway for further imaging in mild TBI patients.

Methods/Design Patients discharged from ED with a panel of 6 biomarkers (GFAP, NFL, NSE, S100B, t-tau and UCH-L1), acute CT < 24 hrs of injury and acute MRI, were extracted from the CENTER-TBI core dataset.2 Mann Whitney U test to compare median biomarker levels in relation to +ve or –ve MRI. Unadjusted Area Under ROC (AUC) calculated for detection of MRI abnormality.

Results/Conclusions 80 patients met inclusion criteria, 45 (56%) male, median age 36.5 yr [IQR 24.5–51.3], median GCS 15 [IQR 15–15]. 17/80 (21.25%) had MRI abnormalities. 1 intraventricular haemorrhage, 2 traumatic subarachnoid haemorrhages, 3 intraparenchymal haemorrhages and 13 DAI. Of the biomarkers (median): GFAP (0.28 vs 1.88 ng/ml, p = 0.002), NSE (13.08 vs 15.19 ng/ml, p= 0.013), S100B (0.06 vs 0.12 µg/L, p=0.002), t-tau (0.82 vs 1.58 pg/ml, p=0.002), UCH-L1 (22.33 vs 57.68 pg/ml p<0.001) were significantly raised in patients with MRI abnormality. Serum NFL concentration was not significant (5.80 vs 8.18 pg/ml, p=0.096). AUC [95% CI] for detection of MRI abnormality: GFAP (0.75 [0.61–0.89]), NFL (0.63 [0.48–0.79]), NSE (0.70 [0.55–0.85]), S100B (0.75 [0.61–0.90]), tau (0.75 [0.61–0.89]), UCH-L1 (0.82 [0.69–0.95])

The results demonstrate potential utility in several acute serum biomarkers for screening of patients with a negative CT. Fair discrimination for detection of MRI pathology in this cohort was demonstrated by GFAP, NSE, S100B, total tau and UCH-L1. Further prospective analysis is required to assess the utility for biomarkers to determine MRI requirement in an ED population.

References

  1. Metting Z, Rödiger LA, De Keyser J, et al. Structural and functional neuroimaging in mild-to-moderate head injury. Lancet Neurol 2007;6:699–710. doi:10.1016/S1474-4422(07)70191-6

  2. Maas AIR, Menon DK, Steyerberg EW, et al. Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): A prospective longitudinal observational study. Neurosurgery 2015;76:67–80. doi:10.1227/NEU.0000000000000575

https://doi.org/10.1136/emj-2020-rcemabstracts.1

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