: The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .
BACKGROUND : Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE : To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion .
The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .
Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention
BACKGROUND : This study compared early serum levels of ubiquitin C-terminal hydrolase ( UCH-L1 ) from patients with mild and moderate traumatic brain injury ( TBI ) with uninjured and injured controls and examined their association with traumatic intracranial lesions on computed tomography ( CT ) scan ( CT positive ) and the need for neurosurgical intervention ( NSI ) . METHODS : This prospect i ve cohort study enrolled adult patients presenting to three tertiary care Level I trauma centers after blunt head trauma with loss of consciousness , amnesia , or disorientation and a Glasgow Coma Scale ( GCS ) score 9 to 15 . Control groups included normal uninjured controls and nonhead injured trauma controls presenting to the emergency department with orthopedic injuries or motor vehicle crash without TBI . Blood sample s were obtained in all trauma patients within 4 hours of injury and measured by enzyme-linked immunosorbent assay for UCH-L1 ( ng/mL ± st and ard error of the mean ) . RESULTS : There were 295 patients enrolled , 96 TBI patients ( 86 with GCS score 13–15 and 10 with GCS score 9–12 ) , and 199 controls ( 176 uninjured , 16 motor vehicle crash controls , and 7 orthopedic controls ) . The AUC for distinguishing TBI from uninjured controls was 0.87 ( 95 % confidence interval [ CI ] , 0.82–0.92 ) and for distinguishing those TBIs with GCS score 15 from controls was AUC 0.87 ( 95 % CI , 0.81–0.93 ) . Mean UCH-L1 levels in patients with CT negative versus CT positive were 0.620 ( ±0.254 ) and 1.618 ( ±0.474 ) , respectively ( p < 0.001 ) , and the AUC was 0.73 ( 95 % CI , 0.62–0.84 ) . For patients without and with NSI , levels were 0.627 ( 0.218 ) versus 2.568 ( 0.854 ; p < 0.001 ) , and the AUC was 0.85 ( 95 % CI , 0.76–0.94 ) . CONCLUSION : UCH-L1 is detectable in serum within an hour of injury and is associated with measures of injury severity including the GCS score , CT lesions , and NSI . Further study is required to vali date these findings before clinical application . LEVEL OF EVIDENCE : II , prognostic study
: The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .
BACKGROUND : Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE : To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion .
The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .