Medico-legal importance of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 in traumatic brain injuries (prospective study)

Abstract Background To determine the validity of malpractice claims, this study sought to determine the medico-legal significance of serum Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-Terminal Hydrolase L1 (UCHL-1) as predictive biomarkers of outcome in mild and moderate traumatic brain injury (TBI). Methods The present study was carried out on 60 admitted TBI cases categorized into a control group which included 20 healthy volunteers; a mildly injured group which included 40 cases of traumatic brain injuries with GCS (13–15); and moderate injured group which included 20 cases of traumatic brain injuries with GCS (9–12) admitted to the neurosurgery department at Ain Shams University Hospitals, serum levels of GFAP and UCHL-1 were evaluated within 12 h. Results There were more male instances than female cases. The age group (18–25 years) represented the most common group subjected to traumatic brain injury, while the age group (> 61 years) was the least common among the studied cases. Serum GFAP and UCHL-1 could differentiate between mild and moderate TBI with 95% and 90% sensitivity and 95% and 75% specificity, respectively. Serum GFAP and UCHL-1 could distinguish between different CT findings with 78.95% and 89.46% sensitivity and 100% and 91.43% specificity, respectively. Conclusion The accuracy of serum GFAP alone was greater than the accuracy of the measurement of both biomarkers, and the accuracy of the combination of all variables was slightly better than that of serum GFAP alone as a predictor of unfavorable outcomes.