: 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 .
Elevated levels of serum glial fibrillary acidic protein breakdown products in mild and moderate traumatic brain injury are associated with intracranial lesions and neurosurgical intervention.
STUDY OBJECTIVE This study examines whether serum levels of glial fibrillary acidic protein breakdown products ( GFAP-BDP ) are elevated in patients with mild and moderate traumatic brain injury compared with controls and whether they are associated with traumatic intracranial lesions on computed tomography ( CT ) scan ( positive CT result ) and with having a neurosurgical intervention . METHODS This prospect i ve cohort study enrolled adult patients presenting to 3 Level I trauma centers after blunt head trauma with loss of consciousness , amnesia , or disorientation and a Glasgow Coma Scale ( GCS ) score of 9 to 15 . Control groups included normal uninjured controls and trauma controls presenting to the emergency department with orthopedic injuries or a motor vehicle crash without traumatic brain injury .  Blood sample s were obtained in all patients within 4 hours of injury and measured by enzyme-linked immunosorbent assay for GFAP-BDP ( nanograms/milliliter ) . RESULTS Of the 307 patients enrolled , 108 were patients with traumatic brain injury ( 97 with GCS score 13 to 15 and 11 with GCS score 9 to 12 ) and 199 were controls ( 176 normal controls and 16 motor vehicle crash controls and 7 orthopedic controls ) . Receiver operating characteristic curves demonstrated that early GFAP-BDP levels were able to distinguish patients with traumatic brain injury from uninjured controls with an area under the curve of 0.90 ( 95 % confidence interval [ CI ] 0.86 to 0.94 ) and differentiated traumatic brain injury with a GCS score of 15 with an area under the curve of 0.88 ( 95 % CI 0.82 to 0.93 ) . Thirty-two patients with traumatic brain injury ( 30 % ) had lesions on CT . The area under these curves for discriminating patients with CT lesions versus those without CT lesions was 0.79 ( 95 % CI 0.69 to 0.89 ) . Moreover , the receiver operating characteristic curve for distinguishing neurosurgical intervention from no neurosurgical intervention yielded an area under the curve of 0.87 ( 95 % CI 0.77 to 0.96 ) . CONCLUSION GFAP-BDP is detectable in serum within an hour of injury and is associated with measures of injury severity , including the GCS score , CT lesions , and neurosurgical intervention . Further study is required to vali date these findings before clinical application
: 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 .