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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0046-1815951
Research Article

Clinical Effectiveness of a Blood-Based Biomarker in Patients with Mild Traumatic Brain Injury

Authors

  • Khemmachat Laovanantaphun

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

  • Khrongwong Musikatavorn

    2   Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

  • Krishnapundha Bunyaratavej 

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Abstract

Objectives

Mild traumatic brain injury (mTBI) is among the most prevalent neurological conditions worldwide. Its diagnosis predominantly depends on computed tomography (CT) imaging, despite the majority of scans yielding negative results, leading to unnecessary resource utilization and avoidable radiation exposure. This study aims to investigate the potential of glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) as serum biomarkers for ruling out clinically significant intracranial injuries.

Materials and Methods

This prospective cohort study enrolled adult patients (aged >18 years) presenting to the emergency department with nonpenetrating mTBI between October 2023 and October 2024. All participants underwent brain CT imaging and venous blood sampling for quantification of GFAP and UCH-L1. Diagnostic performance metrics, including sensitivity, specificity, positive predictive value, and negative predictive value, were calculated to assess biomarker accuracy in detecting intracranial abnormalities.

Results

A total of 123 patients were enrolled, with a mean age of 70 years. The predominant mechanism of injury was a ground-level fall. The combined use of GFAP and UCH-L1 demonstrated excellent sensitivity (100%; 95% CI: 89.1–100%) and negative predictive value (100%; 95% CI: 76.8–100%) for detecting intracranial injury. However, specificity was low (15.4%; 95% CI: 8.7–24.5%), indicating limited ability to rule in pathology based on biomarker elevation alone.

Conclusion

This study demonstrates the high sensitivity and negative predictive value of GFAP and UCH-L1 as a combined biomarker test for evaluating moderate- and high-risk mTBI. Patients with a negative biomarker result may safely forgo head CT, thereby reducing unnecessary radiation exposure and avoiding unwarranted CT utilization. Nevertheless, practical challenges remain before routine clinical adoption is feasible. Future cost analyses will be essential to determine the economic viability of these biomarkers, particularly in resource-limited settings.

Keywords

traumatic brain injury - mild traumatic brain injury - serum biomarkers - head CT scan - ubiquitin C-terminal hydrolase-L1 - glial fibrillary acidic protein

Authors' Contributions

K.L. contributed to conceptualization, methodology, data curation, formal analysis, project administration, and resources, and was responsible for writing the original draft as well as writing, reviewing, and editing the manuscript, including review of the submitted version. K.M. contributed to conceptualization, methodology, data curation, project administration, and resources, and reviewed the submitted version. K.B. contributed to conceptualization, supervision, formal analysis, and project administration, and was involved in writing, reviewing, and editing the manuscript, as well as reviewing the submitted version.


Ethical Approval

The Institutional Review Board of the Faculty of Medicine, Chulalongkorn University, has approved this study in compliance with the international guidelines for human research protection as Declaration of Helsinki, The Belmont Report, CIOMS Guideline, and International Conference on Harmonization in Good Clinical Practice (ICH-GCP) with IRB number 0246/66, COA 615/2023, 599/2024.




Publication History

Article published online:
03 February 2026

© 2026. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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