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Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury

  • Paolo Mastandrea ORCID logo EMAIL logo , Silvia Mengozzi and Sergio Bernardini
Published/Copyright: July 1, 2021
Diagnosis
From the journal Diagnosis Volume 9 Issue 1

Abstract

Traumatic brain injuries (TBIs) and sports-related concussions (SRCs) are the leading causes of hospitalization and death in subjects <45 years old in the USA and Europe. Some biomarkers (BMs) have been used to reduce unnecessary cranial computed tomography (CCT). In recent years, the astroglial S100 calcium-binding B protein (S100B) has prevented approximately 30% of unnecessary CCTs. Glial fibrillary acidic protein (GFAP) has also been studied in direct comparison with S100B. The aim of our cumulative meta-analysis (cMA) is to compare – in the context of hospital emergency departments or SRC conditions – the differences in diagnostic accuracy (DA), sensitivity (Se) and specificity (Sp) of GFAP and S100B. The main cMA inclusion criterion was the assessment of both BMs in the included subjects since 2010, with blood samples drawn 1–30 h from the suspected TBI or SRC. The risk-of-bias (RoB) score was determined, and both the publication bias (with the Begg, Egger and Duval trim-and-fill tests) and sensitivity (with the box-and-whiskers plot) were analyzed for outliers. Seven studies with 899 subjects and nine observations (samples) were included. The diagnostic odds ratios (dORs) with their prediction intervals (PIs), Se and Sp (analyzed with a hierarchical model to respect the binomial data structure) were assessed, and a random-effects MA and a cMA of the difference in the BMs dOR natural logarithms (logOR(G-S)) between the BMs were performed. The cMA of dOR(G-S) was significant (5.78 (CI 2–16.6)) probably preventing approximately 50% of unnecessary CCTs. Further work is needed to standardize and harmonize GFAP laboratory methods.

Keywords: cumulative meta-analysis; diagnostic odds ratio; diagnostic test accuracy; glial fibrillary acidic protein; mild traumatic brain injury; prediction interval; risk of bias; S100 calcium binding protein B; test sensitivity; test specificity
Corresponding author: Paolo Mastandrea, Medical Doctor, Clinical Pathologist, Laboratory of Clinical Pathology, Azienda Ospedaliera “s. G. Moscati”, discesa Campanile 52, Mercato San Severino, Avellino, Italy, Phone: +(39) 3483219932, E-mail: .

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2021-0006)

Received: 2021-01-11
Accepted: 2021-05-17
Published Online: 2021-07-01

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2021-0006
Keywords for this article
cumulative meta-analysis; diagnostic odds ratio; diagnostic test accuracy; glial fibrillary acidic protein; mild traumatic brain injury; prediction interval; risk of bias; S100 calcium binding protein B; test sensitivity; test specificity

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. From Camille Nούς to Apollonian and the Dionysian scientists
  4. Review
  5. The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
  6. Mini Reviews
  7. Updated picture of SARS-CoV-2 variants and mutations
  8. Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury
  9. Opinion Papers
  10. The 6C model for accurately capturing the patient’s medical history
  11. Webside manner: maskless communication
  12. Original Articles
  13. Ways that nurse practitioner students self-explain during diagnostic reasoning
  14. Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain
  15. Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors
  16. Use of a structured approach and virtual simulation practice to improve diagnostic reasoning
  17. Analyzing diagnostic errors in the acute setting: a process-driven approach
  18. Morning report goes virtual: learner experiences in a virtual, case-based diagnostic reasoning conference
  19. Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods
  20. Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality
  21. Automated capture-based NGS workflow: one thousand patients experience in a clinical routine framework
  22. Short Communication
  23. Characterizing the relationship between diagnostic intensity and quality of care
  24. Case Reports – Lessons in Clinical Reasoning
  25. Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and “picking at the air”
  26. Hickam’s dictum, Occam’s razor, and Crabtree’s bludgeon: a case of renal failure and a clavicular mass
  27. Letters to the Editor
  28. Three learning concepts to improve diagnosis and enhance the practice of medicine
  29. Distributed cognition: a framework for conceptualizing telediagnosis in teams
  30. Performance of Fujirebio Espline SARS-CoV-2 rapid antigen test for identifying potentially infectious individuals
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