Photo Credit: Mr. Suphachai Praserdumrongchai
The following is a summary of “GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma,” published in the April 2024 issue of Critical Care by Zylyftari al.
Diagnosing the cause of coma in the field, which is crucial for EMS, might benefit from using glial fibrillary acidic protein (GFAP) as a marker of brain bleeding.
Researchers started a prospective study to investigate whether prehospital GFAP measurements using a point-of-care device can quickly distinguish between intracranial hemorrhage and other causes of acute coma.
They conducted a study at RKH Klinikum Ludwigsburg, a tertiary care hospital near Stuttgart, Germany. Patients with a prehospital diagnosis of acute coma (Glasgow Coma Scale scores 3-8) were enrolled upon admission to the emergency department. Blood samples were taken prehospital. Plasma GFAP measurements were conducted on the i-STAT Alinity® device (Abbott) shortly after hospital admission, with an analysis duration of 15 minutes.
The results showed that in 143 enrolled patients (mean age 65 ± 20 years, 42.7% female), GFAP plasma concentrations were significantly higher in patients with intracranial hemorrhage (n = 51) compared to all other coma causes (3352 pg/mL [IQR 613–10001] vs. 43 pg/mL [IQR 29–91.25], P<0.001). Using an optimal cut-off value of 101 pg/mL, sensitivity for identifying intracranial hemorrhage was 94.1% (specificity 78.9%, positive predictive value 71.6%, negative predictive value 95.9%). Prehospital GFAP values were associated with in-hospital mortality risk.
Investigators concluded that prehospital GFAP measurements using a point-of-care device offered high accuracy in identifying intracranial hemorrhage in acute coma patients, potentially leading to improved triage and management.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04892-5
