The Paper Chase
VIPs of TBI
Brains! Human Brains!
I Object!
Biomarker Bouillabaisse
The Long and Winding Road
100

The results from this trial suggested measuring GFAP and UCH-L1 within 12 hours of head injury could reduce unnecessary head CTs by 30%

What is the ALERT-TBI trial

100

Pain points for this stakeholder group include: patients who are challenging to assess and/or scan, limited quantitative tools to diagnose TBI and scarce departmental resources

Who are ED and FSED directors?

100
mTBI with no head bleed but with persistent clinical symptoms is essentially synonymous with this diagnosis

What is concussion?

100

"I will still send all patients for this test regardless of i-STAT TBI assay results"

What is CT scan?

100

This brain-specific biomarker is a degradation enzyme highly and exclusively express in neurons

What is UCH-L1?

100

This test showed that 94.5% of the TBI patients who received it in US EDs were considered mild

What is the Glascow Coma Scale (GCS)

200

This biomarker outperformed UCH-L1, S100B and NSE for detection of intercranial MRI abnormalities in the Yue and Korley study

What is GFAP?

200

Benefits of i-STAT TBI adoption for this stakeholder group include effectively triaging patients and reducing ED referrals 

Who are moderately-complex Urgent Care medical directors/owners?

200

Following TBI, there is permeability of this, allowing proteins to serve as potential biomarkers

What is the blood-brain barrier?

200

"Test sensitivity is good, but the low percent of this is concerning to me"

What is specificity?

200

UCH-L1 levels in the blood can distinguish between these patient types

What are patients with mTBI and those without injuries?

200

Some facilities do not have this on premises, limiting on-site assessment to clinical decision rules and observation

What is CT?

300

This percentage of negative patients in the pivotal study had a true negative result on the i-STAT TBI Plasma test, suggesting a potential reduction in unnecessary CT in this percentage of patients 

What is 40%?

300

This stakeholder oversees a multidisciplinary team providing evaulation and treatment of TBIs 

Who is the concussion clinic medical director

300

GFAP elevations correlate with extent of brain injury even in patients with this type of condition

What is mTBI?

300

"We use these to rule out CT for TBI patients"

What are CDRs (Clinical Decision Rules)?

300

GFAP is a specific marker of this kind of injury

What is astrocyte injury in either white or gray matter that is elevated in patients with traumatic intercranial abnormalities on CT

300

This care setting is where mTBI patients may go for long-term follow-up IF their mTBI is identified in the ED

What is a concussion clinic?

400

This was a prospective cohort study that enrolled patients with TBI who had a clinically indicated head CT scan within 24-hours of injury at 18 Level One trauma centers in the U.S.

What is TRACK-TBI

400

This stakeholder is focused on helping TBI patients who may be victims of IPV (intimate partner violence)

What is forensic nursing (SANE/SAFE)?

400

This was the most common mechanism of injury in patients presenting with a GCS score of 13-15 according to the Bazarian paper

What is a fall?

400

"I don't want to spend funds on a TBI assay because I'm concerned about lack of this.."

What is reimbursement for the TBI assay?

400

These levels peak at 0 to 8 hours post-injury and slowly declines 72 hours after brain injury

What are serum UCH-L1 levels?

400

This is the average wait time for an ED patient to receive a head CT scan

What is >3 hours?

500

From the Korley study-GFAP can be used as a biomarker for traumatic intracranial lesions found on this imaging modality but undetectable on CT

What is MRI?

500

Neurologists, PT, OT speech therapists and psychologists may play a role in patient care for this site of service

What is a concussion clinic?

500

In patients with a GCS between 13-15, 93.7% showed this result upon CT scan

What is no traumatic injury?

500

"I don't want to be the first account to start using the i-STAT TBI test because there's a lack of these to guide my practice"

What are guidelines that include the i-STAT TBI assay?

500

Unlike previously studied biomarkers, GFAP levels are not affected by these factors

What is extracranial trauma, exercise, age or skin tone?

500

This site of service is more likely to see sports-related TBIs, especially on nights and weekends

What is a moderately complex Urgent Care Clinic?

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