Globally, pediatric traumatic brain injury (TBI) is a significant cause of neurodisability, with a disproportionate burden in low-resource countries with limited neuroimaging access. Blood biomarkers may aid in diagnosis and triage. We evaluated glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) in Ugandan children with TBI to assess their utility in predicting injury severity, computed tomography (CT) abnormalities, and short-term neurodisability. This prospective study was conducted at Mulago National Referral Hospital in Uganda (2022–2024). Children aged 5–15 years with TBI were enrolled within 48 h of injury, along with uninjured controls. TBI severity was classified using the Glasgow Coma Scale as mild (13–15) or moderate/severe (≤12). CT was performed when clinically indicated. Plasma GFAP and UCH-L1 were measured using the Abbott i-STAT® Alinity platform. Neurological assessments were completed at admission, discharge, and 2-week follow-up. Biomarkers were compared across TBI severity, CT status, and neurological outcomes. Diagnostic performance was assessed using receiver operating curve analysis and logistic regression. Sixty-five children with TBI (mean SD age 9.13 3.06 years; 58% male) and 40 controls (10.27 2.87 years; 60% male) were included. TBI patients had significantly elevated biomarker levels (GFAP: 704 vs. 30 pg/mL; UCH-L1: 80 vs. 40 pg/mL; p ≤ 0.01). GFAP was higher in moderate/severe vs. mild TBI ( p = 0.006), showed excellent diagnostic performance (area under the curve AUC 0.93), and severity discrimination (AUC 0.74). GFAP predicted CT abnormalities (AUC 0.87) and neurological deficits at discharge and follow-up (OR 3.06; 3.37). UCH-L1 added limited value to combined models. GFAP showed strong diagnostic and prognostic potential for pediatric TBI and may aid in early diagnosis and triage where CT is unavailable.
Datta et al. (Thu,) studied this question.