قالب وردپرس درنا توس
Home / Health / Blood test may be able to predict need for CT scan after a head injury

Blood test may be able to predict need for CT scan after a head injury




<div _ngcontent-c16 = "" innerhtml = "

With a significant number of CT scans for routine head injuries across the US – coupled with excessive costs, not to mention radiation exposure – researchers have investigated Whether the first order of a blood test can reduce or even eliminate the need for a CT scan.

Blood Vial (Courtesy of Shutterstock)

One of the main reasons why doctors order a head CT is an intracranial hemorrhage exclude or have a skull fracture, two potentially dangerous injuries, but a "normal" head CT still does not rule out the possibility of a concussion that could reflect an injury at the cellular or metabolic level.

There have been a number of blood biomarkers studied over the past decade with its promise as a potential candidate for the secure Vo predicting the chances of a brain injury, but the sensitivity and the negative predictive value (NPV) were not sufficient to safely detect or exclude such an injury [1

9659003]

Results of a new study suggest that a highly sensitive blood test can accurately and reliably determine if a CT scan is necessary in patients with suspected craniocerebral trauma (TBI).

The study was published earlier this week Lancet Neurology .

Researchers examined nearly 2,000 adults who went on an ER visit following a head injury, with a persistent suspicion of TBI. Patients had collected a head CT and blood sample within 12 hours of head trauma and collected blood to verify the presence of two biomarker proteins released into the bloodstream after TBI: C-terminal hydrolase L1 (UCH). L1) and glial fibrillary acidic protein (GFAP).

The results were promising. In more than 96% of patients studied a blood test using both biomarkers accurately predicted the absence of any brain injury as confirmed by a CT scan. The study also found that up to 1/3 of CT scans could be safely avoided, based on normal CT imaging obtained in this subgroup in the study. The biomarker results – 97.6% of patients with a CT-proven intracranial injury such as positive bleeding and 99.7% of patients with a negative test who had a normal head CT scan – were quite impressive.

In clinical practice, especially in a labor-intensive emergency situation involving multiple patients with multiple head injuries, such a blood test could potentially identify patients who really need a CT scan. But their greater value lies in eliminating the need for a CT scan in those patients in whom you would normally order one, based on anamnesis and clinical examination with the Glasgow Coma Scale (GCS) – a clinical examination that uses verbal, eye and motor function, a score of 3-15. These include patients with a GCS score of 13-15 who reflect a mild head injury.

TBI leads to more than 2.5 million ER visits annually, with the majority rated as mild TBI or concussion. However, these 2.5 million TBI visits annually generate more than 20 million head CTs to assess for craniocerebral injury so the authors of the study. However, the data show that the prevalence of intracranial lesions detected by CT with mild TBI is below 10%, suggesting the need to first "screen" patients with a blood test before ordering a CT scan.

A traumatic injury to the head causes damage to the proteins in the brain cells, which then enter the bloodstream and pass through the blood-brain barrier, which becomes permeable or "leaky" as a result of the trauma. While the biomarker S100B is already in use in Europe, such a biomarker has not yet been approved by the FDA for clinical use in the US – although the two biomarkers have been technically approved as a panel by the FDA in February 2018.

Known as the "Brain Trauma Indicator" The biomarkers were reviewed as part of a special program, the FDA's "De Novo Premarket Review Pathway": "A regulatory pathway for some low-to-medium risk devices that are new and for which there is no legally approved developer ice cream. "

The FDA has allowed the marketing of the Brain Trauma Indicator Panel to Banyan Biomarkers, Inc., but the panel is not yet commercially available or clinically available. It still remains essentially a research tool.

The biomarkers in this recent study – UCH-L1 and GFAP – were promising, but were limited by previous studies involving a small number of patients, and had differences in sample time samples after injury as well as retrospective assignments of cut-offs Values ​​

To better circumvent these limitations, researchers developed the current ALERT-TBI study, a prospective study of 22 sites worldwide. The aim was to investigate the combination of both biomarkers as a way to predict injury within 12 hours of CT scan injury.

Thus, the results of this study will change the clinician's approach to imaging individuals with TBI.

Probably not, "said Raj K. Narayan, MD, Professor and Chair, Department of Neurosurgery and Director, Northwell Neuroscience Institute, Sugar School of Medicine at Hofstra / Northwell." Patients with TBI are a very diverse group and their symptoms can be very different. Many older adults are blood thinning – the medical risk of hematoma [brain bleed] is very high in the US "

" For all these reasons and more, it is generally advisable to do a first CT scan on each one who presents with a story of having suffered a head injury. However, biomarkers can provide additional information about the severity of the injury – their value must be determined in practice, "says Narayan.

This results in continued development of several biomarkers for the evaluation of patients with TBI, but the prevailing consensus is that they are not prepared for use in the office, ER, or in-situ areas during athletic competitions until additional studies confirm their clinical utility.

"We have been searching for TBI-specific biomarkers for decades, Narayan said. "We now have a few candidates, but they are not currently used clinically in the US, although S100B can be used in Europe."

"I am sure that there will be more and I hope that they will add another dimension to the assessment of the TBI patient." For the time being, the history and examination, supplemented by a CT scan, remains Mainstay of evaluation of the TBI patient, "he advised.

While no bleeding or brain swelling (edema) may be seen on a CT scan After TBI, there may still be significant clinical signs of brain damage that may indicate concussion that is not CT scans or even specialized MRI scans is observed.

"This study demonstrates the power of a serum biomarker test to determine whether a CT scan will be positive or not, which could certainly help reduce unnecessary imaging," said Drs. Uzma Samadani, Associate Professor, Department of Neurosurgery, University of Minnesota, Rockswold Kaplan Endowed Chair of Traumatic Brain Injury Research, Hennepin County Medical Center. "But I warn against the title of the study being slightly misleading in that it is possible to suffer brain damage without positive CT findings."

Imaging modalities can not fully explain the range of injuries that occur after head trauma. Samadani explains, "Since the discovery of CT scanning technology, we have defined radiology to define brain injury, but many pathophysiologies related to brain injury are not seen in CT." A concussion is a brain injury that is radiographically occult. This study shows that because the serum marker assay correlates with CT scan results, it is not useful for detecting concussions that are a form of intracranial injury, "she concluded.

>>

With a significant number of CT scans for routine head injuries across the US – coupled with excessive costs, not to mention radiation exposure – researchers have investigated whether first ordering a blood test will reduce or even eliminate the need for one CT scans.

Vial of Blood (by courtesy of Shutterstock)

One of the main reasons why doctors order a head CT is an intracranial hemorrhage or skull fracture, two potentially dangerous injuries. However, a "normal" head CT always excludes not yet the possibility of a concussion that could reflect an injury at the cellular or metabolic level.

Over the past decade, a number of blood biomarkers have been studied that are promising candidates for predicting the chances of a brain injury, but the sensitivity and the negative predictive value (NPV) were not sufficient to ensure such an injury to detect or exclude.

Results of a new study n They suggest that a highly sensitive blood test can accurately and reliably determine if a CT scan is needed in patients suspected of having craniocerebral trauma (TBI)

Week in Lancet Neurology Released

The researchers looked at nearly 2,000 adults who made an ER visit following a head injury, with a persistent suspicion of TBI. Patients had collected a head CT and blood sample within 12 hours of head trauma and collected blood to verify the presence of two biomarker proteins released into the bloodstream after TBI: C-terminal hydrolase L1 (UCH). L1) and glial fibrillary acidic protein (GFAP).

The results were very promising. In more than 96% of the patients studied a blood test using both biomarkers accurately predicted the absence of any brain injury as confirmed by a CT scan. The study also found that up to 1/3 of CT scans based on normal CT imaging results in this subgroup could be safely avoided in the study. The biomarker results – 97.6% of patients with a CT-proven intracranial injury such as positive bleeding and 99.7% of patients with a negative test who had a normal head CT scan – were quite impressive.

In clinical practice, especially in a labor-intensive emergency situation involving multiple patients with multiple head injuries, such a blood test could potentially identify patients who really need a CT scan. But their greater value lies in eliminating the need for a CT scan in those patients in whom you would normally order one, based on anamnesis and clinical examination with the Glasgow Coma Scale (GCS) – a clinical examination that uses verbal, eye and motor function, a score of 3-15. These include patients with a GCS score of 13-15 who reflect a mild head injury.

TBI leads to more than 2.5 million ER visits annually, with the majority rated as mild TBI or concussion. However, these 2.5 million TBI visits annually generate more than 20 million head CTs to assess for craniocerebral injury so the authors of the study. However, the data show that the prevalence of intracranial lesions detected by CT with mild TBI is below 10%, suggesting the need to first "screen" patients with a blood test before ordering a CT scan.

A traumatic injury to the head causes damage to the proteins in the brain cells, which then enter the bloodstream and pass through the blood-brain barrier, which becomes permeable or "leaky" as a result of the trauma. While the biomarker S100B is already in use in Europe, such a biomarker has not yet been approved by the FDA for clinical use in the US – although the two biomarkers have been technically approved as a panel by the FDA in February 2018.

Known as the "Brain Trauma Indicator" The biomarkers were reviewed as part of a special program, the FDA's "De Novo Premarket Review Pathway": "A regulatory pathway for some low-to-medium risk devices that are new and for which there is no legally approved developer ice cream. "

The FDA has allowed the marketing of the Brain Trauma Indicator Panel to Banyan Biomarkers, Inc., but the panel is not yet commercially available or clinically available. It still remains essentially a research tool.

The biomarkers in this recent study – UCH-L1 and GFAP – were promising, but were limited by previous studies involving a small number of patients, and had differences in sample time samples after injury as well as retrospective assignments of cut-offs Values ​​

To better circumvent these limitations, researchers developed the current ALERT-TBI study, a prospective study of 22 sites worldwide. The aim was to investigate the combination of both biomarkers as a way to predict injury within 12 hours of CT scan injury.

Thus, the results of this study will change the clinician's approach to imaging individuals with TBI.

Probably not, "said Raj K. Narayan, MD, Professor and Chair, Department of Neurosurgery and Director, Northwell Neuroscience Institute, Sugar School of Medicine at Hofstra / Northwell." Patients with TBI are a very diverse group and their symptoms can be very different. Many older adults are blood thinning – the medical risk of hematoma [brain bleed] is very high in the US "

" For all these reasons and more, it is generally advisable to do a first CT scan on each one who presents with a story of having suffered a head injury. However, biomarkers can provide additional information about the severity of the injury – their value must be determined in practice, "says Narayan.

This results in continued development of several biomarkers for the evaluation of patients with TBI, but the prevailing consensus is that they are not prepared for use in the office, ER, or in-situ areas during athletic competitions until additional studies confirm their clinical utility.

"We have been searching for TBI-specific biomarkers for decades, Narayan said. "We now have a few candidates, but they are not currently used clinically in the US, although S100B can be used in Europe."

"I am sure that there will be more and I hope that they will add another dimension to the assessment of the TBI patient." For the time being, the history and examination, supplemented by a CT scan, remains Mainstay of evaluation of the TBI patient, "he advised.

While no bleeding or brain swelling (edema) may be seen on a CT scan After TBI, there may still be significant clinical signs of brain damage that may indicate concussion that is not CT scans or even specialized MRI scans is observed.

"This study demonstrates the power of a serum biomarker test to determine whether a CT scan will be positive or not, which could certainly help reduce unnecessary imaging," said Drs. Uzma Samadani, Associate Professor, Department of Neurosurgery, University of Minnesota, Rockswold Kaplan Endowed Chair of Traumatic Brain Injury Research, Hennepin County Medical Center. "But I warn against the title of the study being slightly misleading in that it is possible to suffer brain damage without positive CT findings."

Imaging modalities can not fully explain the range of injuries that occur after head trauma. Samadani explains, "Since the discovery of CT scanning technology, we have defined radiology to define brain injury, but many pathophysiologies related to brain injury are not seen in CT." A concussion is a brain injury that is radiologically occult. This study shows that, because the serum marker assay correlates with CT scan results, it is not suitable for detecting concussion, which is a form of intracranial injury, "she concluded.


Source link