LAUSR

Key Points Question How does the diagnostic performance of serum glial fibrillary acidic protein (GFAP) and neuronal ubiquitin C-terminal hydrolase (UCH-L1) biomarkers compare with that of validated clinical decision rules for detecting intracranial lesions on computed tomography (CT) of the head in patients with mild traumatic brain injury, and is a combination of biomarkers and clinical decision rules associated with improved performance? Findings In this cohort of 349 patients with mild traumatic brain injury, the Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), and GFAP plus UCH-L1 had 100% sensitivity for detecting lesions on CT, but the CCHR had the highest specificity (33%), followed by GFAP plus UCH-L1 (25%) and the NOC (16%). The combination of GFAP level and the CCHR yielded the highest diagnostic performance. Meaning These findings suggest that although GFAP plus UCH-L1 and the clinical decision rules performed similarly in detecting intracranial lesions on CT scans, the diagnostic performance was improved when biomarkers were combined with rules, specifically GFAP with the CCHR.