Glial Fibrillary Acidic Protein Performance as A Biomarker for Mild Traumatic Brain Injury Among Children A Systematic Review and Meta-Analysis of Cohort Studies

Main Article Content

Ade Gautama
Gideon Hot Partogi Sinaga
Muhammad Kevin Ardian

Abstract

Introduction: Traumatic brain injury (TBI) is common in children, affecting over 837,000 children each year. TBI is caused by a bump to the head, which disrupts the brain's normal function. In children, mild traumatic brain injury (mTBI) is usually asymptomatic. Therefore, mTBI may be undetected and may lead to memory and coordination disorders. The gold standard for detecting TBI is a computerized tomography (CT) scan. Unfortunately, the radiation from this modality in earlier life will expose children to danger. Hence, we wanted to analyze glial fibrillary acidic protein (GFAP) as a potential new biomarker for mTBI diagnosis.


Objective: To explore the utility of GFAP in the detection of mTBI by analyzing post-injury GFAP serum levels and evaluating the area under the curve (AUC) when used as a diagnostic tool.


Material and Methods: This review selects cohort studies on three databases (PubMed, Scopus, and ClinicalKey) systematically using the PRISMA guideline. The search results were screened using established inclusion and exclusion criteria, before being included in qualitative and quantitative analysis. Critical appraisal and risk of bias were conducted using the STROBE checklist for cohort studies.


Results and Discussion: This review yielded four studies with a total of 379 subjects. The quantitative analysis showed a significant difference in GFAP serum level between case and control groups (MD:0.62; 95% CI: 0.48-0.75; p<0.001). AUC value ranges from 0.8-0.89, which is considered adequate. GFAP also had a higher AUC than other blood biomarkers for detecting mTBI. The heterogeneity between the studies was moderate (I2:59%; p<0.00001).


Conclusion: In conclusion, GFAP is significantly higher in children with mTBI and exceeded other blood biomarkers. Therefore, GFAP may be proposed as a potential screening tool for mTBI.

Article Details

How to Cite
Gautama, A., Sinaga, G. H. P. and Ardian, M. K. (2021) “Glial Fibrillary Acidic Protein Performance as A Biomarker for Mild Traumatic Brain Injury Among Children: A Systematic Review and Meta-Analysis of Cohort Studies”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia. Available at: https://jamsa.amsa-international.org/index.php/main/article/view/309 (Accessed: 26July2021).
Section
Scientific Posters (AMSC Academic Competition)

References

World Health Organization. (2006). Neurological disorders public health challenges. In World Health Organization Press (Vol. 54, Issue 7).

Frieden TR. Traumatic brain injury in the United States: epidemiology and rehabilitation. InCDC and NIH Report to Congress 2015 (pp. 1-74).

Papa L. In children and youth with mild and moderate traumatic brain injury, glial fibrillary acidic protein out-performs S100β in detecting traumatic intracranial lesions on computed tomography. Journal of neurotrauma. 2016 Jan 1;33(1):58-64.

Papa L. Performance of glial fibrillary acidic protein in detecting traumatic intracranial lesions on computed tomography in children and youth with mild head trauma. Academic Emergency Medicine. 2015 Nov;22(11):1274-82.

Brunkhorst R. Astroglial proteins as diagnostic markers of acute intracerebral hemorrhage—pathophysiological background and clinical findings. Translational Stroke Research. 2010 Dec;1(4):246-51.

Mondello S. Serum concentrations of ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein after pediatric traumatic brain injury. Scientific reports. 2016 Jun 20;6(1):1-8.

Papa L. Evaluating glial and neuronal blood biomarkers GFAP and UCH-L1 as gradients of brain injury in concussive, subconcussive and non