Serum Glial Fibrillary Acidic Protein in Detecting Intracranial Injuries Following Minor Head Trauma; a Systematic Review and Meta-Analysis

Developing novel diagnostic and screening tools for exploring intracranial injuries following mi-nor head trauma is a necessity. This study aimed to evaluate the diagnostic value of serum glial fibrillary acidicprotein (GFAP) in detecting intracranial injuries following minor head trauma.

An extensive searchwas performed in Medline, Embase, Scopus, and Web of Science databases up to the end of April 2022. Hu-man observational studies were chosen, regardless of sex and ethnicity of their participants. Pediatrics studies,report of diagnostic value of GFAP combined with other biomarkers (without reporting the GFAP alone), arti-cles including patients with all trauma severity, defining minor head trauma without intracranial lesions as theoutcome of the study, not reporting sensitivity/specificity or any other values essential for computation of truepositive, true negative, false positive and false-negative, being performed in the prehospital setting, assessingthe prognostic value of GFAP, duplicated reports, preclinical studies, retracted articles, and review papers wereexcluded. The result was provided as pooled sensitivity, specificity, diagnostic score and diagnostic odds ratio,and area under the summary receiver operating characteristic (SROC) curve with a 95% confidence interval (95%CI).

Eventually, 11 related articles were introduced into the meta-analysis. The pooled analysis impliesthat the area under the SROC curve for serum GFAP level in minor traumatic brain injuries (TBI) was 0.75 (95%CI: 0.71 to 0.78). Sensitivity and specificity of this biomarker in below 100 pg/ml cut-off were 0.83 (95% CI: 0.78to 0.89) and 0.39 (95% CI: 0.24 to 0.53), respectively. The diagnostic score and diagnostic odds ratio of GFAP indetection of minor TBI were 1.13 (95% CI: 0.53 to 1.74) and 3.11 (95% CI: 1.69 to 5.72), respectively. The level ofevidence for the presented results were moderate.

The present study’s findings demonstrate thatserum GFAP can detect intracranial lesions in mild TBI patients. The optimum cut-off of GFAP in detection ofTBI was below 100 pg/ml. As a result, implementing serum GFAP may be beneficial in mild TBI diagnosis forpreventing unnecessary computed tomography (CT) scans and their related side effects.