Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review

Background: Mild traumatic brain injury (mTBI) accounts for 80% of TBI cases. Although only 16% show intracranial lesions and <1% require neurosurgical intervention, CT overutilization remains common. Clinical decision rules like the Canadian CT Head Rule achieve high sensitivity (≈100%) but poor...

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Autores: Salgado, Sebastián, Saver, Vicente, Sáenz, Ángel, Ferre, Andrés, Giglio, Andres, Reccius, Andrés
Tipo de recurso: artículo
Fecha de publicación:2026
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/26608
Acceso en línea:https://hdl.handle.net/20.500.13003/26608
Access Level:acceso abierto
Palabra clave:Biomarkers
Brain injuries
Clinical decision rules
Emergency service
Glial fibrillary acidic protein
Hospital
Multidetector computed tomography
Traumatic
Ubiquitin thiolesterase
Unnecessary procedures
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spelling Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative reviewSalgado, SebastiánSaver, VicenteSáenz, ÁngelFerre, AndrésGiglio, AndresReccius, AndrésBiomarkersBrain injuriesClinical decision rulesEmergency serviceGlial fibrillary acidic proteinHospitalMultidetector computed tomographyTraumaticUbiquitin thiolesteraseUnnecessary proceduresBackground: Mild traumatic brain injury (mTBI) accounts for 80% of TBI cases. Although only 16% show intracranial lesions and <1% require neurosurgical intervention, CT overutilization remains common. Clinical decision rules like the Canadian CT Head Rule achieve high sensitivity (≈100%) but poor specificity (28-65%). Serum biomarkers, particularly GFAP and UCH-L1, offer complementary diagnostic performance. Emerging evidence suggests combining both strategies may optimize diagnostic accuracy, though integrated approaches remain poorly characterized in the literature. Methods: We conducted a narrative review of literature published January 2000-March 2025 across PubMed/MEDLINE, Google Scholar, and Scielo. Search terms included mTBI, biomarkers (GFAP, UCH-L1, S100B), clinical decision rules (Canadian CT Head Rule, New Orleans Criteria, NEXUS), and resource-limited settings. Inclusion criteria comprised observational cohorts, clinical trials, validation studies, systematic reviews, and meta-analyses focused on mTBI in emergency contexts. Results: Combined strategies integrating clinical decision rules with biomarkers achieved superior diagnostic performance compared to either tool individually. The Canadian CT Head Rule demonstrated optimal performance across GCS 13-15 (sensitivity 93-100% and specificity 28-65% for intracranial lesions). GFAP demonstrated superior diagnostic performance compared with UCH-L1 and S100B. Although UCH-L1 did not provide meaningful incremental value beyond GFAP alone, all currently FDA- and CE-cleared platforms for clinical use (Abbott i-STAT, Alinity i; bioMérieux VIDAS® TBI) measure both GFAP and UCH-L1 in combination, achieving sensitivities of 95.8–97.3% and specificities of 34.2–41.2%. Conclusion: Integrating the Canadian CT Head Rule with GFAP-based biomarker testing may optimize CT utilization in mTBI. We propose a sequential diagnostic algorithm consisting of initial evaluation with the Canadian CT Head Rule, followed by biomarker testing in CCHR-positive cases, with CT reserved for biomarker-positive patients. This stepwise approach has the potential to support more efficient referral decisions and resource utilization in settings with limited access to neuroimaging, while reducing unnecessary brain CT use in centers with imaging availability, adapting to diverse healthcare contexts. Cost-effectiveness analyses and validation in resource-limited environments remain needed.Springer Science and Business Media LLC20262026-01-2420262026-01-24research articlehttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.13003/26608reponame:Docusalutinstname:Conselleria de Salut i Consum del Govern de les Illes BalearsInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:docusalut.com:20.500.13003/266082026-06-22T12:44:07Z
dc.title.none.fl_str_mv Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review
title Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review
spellingShingle Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review
Salgado, Sebastián
Biomarkers
Brain injuries
Clinical decision rules
Emergency service
Glial fibrillary acidic protein
Hospital
Multidetector computed tomography
Traumatic
Ubiquitin thiolesterase
Unnecessary procedures
title_short Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review
title_full Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review
title_fullStr Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review
title_full_unstemmed Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review
title_sort Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review
dc.creator.none.fl_str_mv Salgado, Sebastián
Saver, Vicente
Sáenz, Ángel
Ferre, Andrés
Giglio, Andres
Reccius, Andrés
author Salgado, Sebastián
author_facet Salgado, Sebastián
Saver, Vicente
Sáenz, Ángel
Ferre, Andrés
Giglio, Andres
Reccius, Andrés
author_role author
author2 Saver, Vicente
Sáenz, Ángel
Ferre, Andrés
Giglio, Andres
Reccius, Andrés
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Biomarkers
Brain injuries
Clinical decision rules
Emergency service
Glial fibrillary acidic protein
Hospital
Multidetector computed tomography
Traumatic
Ubiquitin thiolesterase
Unnecessary procedures
topic Biomarkers
Brain injuries
Clinical decision rules
Emergency service
Glial fibrillary acidic protein
Hospital
Multidetector computed tomography
Traumatic
Ubiquitin thiolesterase
Unnecessary procedures
description Background: Mild traumatic brain injury (mTBI) accounts for 80% of TBI cases. Although only 16% show intracranial lesions and <1% require neurosurgical intervention, CT overutilization remains common. Clinical decision rules like the Canadian CT Head Rule achieve high sensitivity (≈100%) but poor specificity (28-65%). Serum biomarkers, particularly GFAP and UCH-L1, offer complementary diagnostic performance. Emerging evidence suggests combining both strategies may optimize diagnostic accuracy, though integrated approaches remain poorly characterized in the literature. Methods: We conducted a narrative review of literature published January 2000-March 2025 across PubMed/MEDLINE, Google Scholar, and Scielo. Search terms included mTBI, biomarkers (GFAP, UCH-L1, S100B), clinical decision rules (Canadian CT Head Rule, New Orleans Criteria, NEXUS), and resource-limited settings. Inclusion criteria comprised observational cohorts, clinical trials, validation studies, systematic reviews, and meta-analyses focused on mTBI in emergency contexts. Results: Combined strategies integrating clinical decision rules with biomarkers achieved superior diagnostic performance compared to either tool individually. The Canadian CT Head Rule demonstrated optimal performance across GCS 13-15 (sensitivity 93-100% and specificity 28-65% for intracranial lesions). GFAP demonstrated superior diagnostic performance compared with UCH-L1 and S100B. Although UCH-L1 did not provide meaningful incremental value beyond GFAP alone, all currently FDA- and CE-cleared platforms for clinical use (Abbott i-STAT, Alinity i; bioMérieux VIDAS® TBI) measure both GFAP and UCH-L1 in combination, achieving sensitivities of 95.8–97.3% and specificities of 34.2–41.2%. Conclusion: Integrating the Canadian CT Head Rule with GFAP-based biomarker testing may optimize CT utilization in mTBI. We propose a sequential diagnostic algorithm consisting of initial evaluation with the Canadian CT Head Rule, followed by biomarker testing in CCHR-positive cases, with CT reserved for biomarker-positive patients. This stepwise approach has the potential to support more efficient referral decisions and resource utilization in settings with limited access to neuroimaging, while reducing unnecessary brain CT use in centers with imaging availability, adapting to diverse healthcare contexts. Cost-effectiveness analyses and validation in resource-limited environments remain needed.
publishDate 2026
dc.date.none.fl_str_mv 2026
2026-01-24
2026
2026-01-24
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.13003/26608
url https://hdl.handle.net/20.500.13003/26608
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Springer Science and Business Media LLC
publisher.none.fl_str_mv Springer Science and Business Media LLC
dc.source.none.fl_str_mv reponame:Docusalut
instname:Conselleria de Salut i Consum del Govern de les Illes Balears
instname_str Conselleria de Salut i Consum del Govern de les Illes Balears
reponame_str Docusalut
collection Docusalut
repository.name.fl_str_mv
repository.mail.fl_str_mv
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