Validity and clinical utility of brain injury biomarkers in the assessment and risk stratification of mild traumatic brain injury in emergency departments

Miriam Escalante-Reyes; Antonio Tejera-Muñoz; Iván González-Hermoso; Paula Sirera-Sirera; Rocío Alfayate-Guerra; Pere Llorens

doi:10.1016/j.medcli.2026.107406

Validity and clinical utility of brain injury biomarkers in the assessment and risk stratification of mild traumatic brain injury in emergency departments

Med Clin (Barc). 2026 Mar 12;166(5):107406. doi: 10.1016/j.medcli.2026.107406. Online ahead of print.

[Article in English, Spanish]

Authors

Miriam Escalante-Reyes¹, Antonio Tejera-Muñoz², Iván González-Hermoso³, Paula Sirera-Sirera³, Rocío Alfayate-Guerra³, Pere Llorens⁴

Affiliations

¹ Servicio de Análisis Clínicos, Hospital General Universitario Dr. Balmis de Alicante, Alicante, España. Electronic address: miriamescalante96@gmail.com.
² Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis de Alicante, Alicante, España.
³ Servicio de Análisis Clínicos, Hospital General Universitario Dr. Balmis de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis de Alicante, Alicante, España.
⁴ Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis de Alicante, Alicante, España; Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis de Alicante, Alicante, España.

PMID: 41832802
DOI: 10.1016/j.medcli.2026.107406

Abstract

Background and objective: The diagnosis of intracranial injury (ICI) after mild traumatic brain injury (TBI) is made using cranial computed tomography (CT), a technique that involves radiation and waiting times in the emergency department. Serum biomarkers, such as S100β, GFAP, and UCH-L1, could be rapid and efficient alternatives for ruling out ICI.

Materials and methods: This was a cross-sectional observational study evaluating diagnostic tests in adult patients treated in the emergency department between 2023 and 2024 for mild TBI, who underwent cranial CT and serum determination of these biomarkers.

Results: A total of 329 patients with a mean age of 77 years were included, 59.3% of whom were women. 8.4% showed ICI on cranial CT. Sensitivity was 92.9% and negative predictive value was 96.3% in TBI test (GFAP+UCH-L1), higher than that of S100β. Patients with ICI had higher GFAP concentrations.

Conclusions: TBI test, and more specifically GFAP, showed greater diagnostic performance, supporting its use as a tool to optimize the indication for cranial CT in the emergency department after mild TBI.

Keywords: Brain injuries; Glial fibrillary acidic protein; Human UCHL1 protein; Lesiones traumáticas del encéfalo; Proteína L1 UCH; Proteína ácida fibrilar de la glía; S100 calcium binding protein beta subunit; Subunidad beta de la proteína de unión al calcio S100; Tomografía computarizada por rayos X; X-ray computed tomography.