The Paper Chase
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
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?
What is concussion?
"I will still send all patients for this test regardless of i-STAT TBI assay results"
What is CT scan?
This brain-specific biomarker is a degradation enzyme highly and exclusively express in neurons
What is UCH-L1?
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)
This biomarker outperformed UCH-L1, S100B and NSE for detection of intercranial MRI abnormalities in the Yue and Korley study
What is GFAP?
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?
Following TBI, there is permeability of this, allowing proteins to serve as potential biomarkers
What is the blood-brain barrier?
"Test sensitivity is good, but the low percent of this is concerning to me"
What is specificity?
UCH-L1 levels in the blood can distinguish between these patient types
What are patients with mTBI and those without injuries?
Some facilities do not have this on premises, limiting on-site assessment to clinical decision rules and observation
What is CT?
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%?
This stakeholder oversees a multidisciplinary team providing evaulation and treatment of TBIs
Who is the concussion clinic medical director
GFAP elevations correlate with extent of brain injury even in patients with this type of condition
What is mTBI?
"We use these to rule out CT for TBI patients"
What are CDRs (Clinical Decision Rules)?
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
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?
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
This stakeholder is focused on helping TBI patients who may be victims of IPV (intimate partner violence)
What is forensic nursing (SANE/SAFE)?
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?
"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?
These levels peak at 0 to 8 hours post-injury and slowly declines 72 hours after brain injury
What are serum UCH-L1 levels?
This is the average wait time for an ED patient to receive a head CT scan
What is >3 hours?
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?
Neurologists, PT, OT speech therapists and psychologists may play a role in patient care for this site of service
What is a concussion clinic?
In patients with a GCS between 13-15, 93.7% showed this result upon CT scan
What is no traumatic injury?
"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?
Unlike previously studied biomarkers, GFAP levels are not affected by these factors
What is extracranial trauma, exercise, age or skin tone?
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?