Evidence map›Paper›PMID 32464528›Full record

Trial reportEBioMedicine2020

Blood biomarkers on admission in acute traumatic brain injury: Relations to severity, CT findings and care path in the CENTER-TBI study.

Endre Czeiter, Krisztina Amrein, Benjamin Y Gravesteijn, Fiona Lecky, David K Menon, Stefania Mondello, Virginia F J Newcombe, Sophie Richter, Ewout W Steyerberg, Thijs Vande Vyvere and 7 more

2 registry-linked trialsOpen access · goldAbstract readClinical TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in EBioMedicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 161 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
161citing papers in PubMed, 9 pooled it
13.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06163833 phase2recruitingnot on this mapstarted 2023, after this paper: background citation

MATRIx: MesenchymAl Stromal Cells for Traumatic bRain Injury

TypeinterventionalSponsorFondazione IRCCS San Gerardo dei TintoriRan2023 to 2026Enrolled78ConditionsTraumatic Brain Injury With Loss of ConsciousnessArmsMesenchymal stromal cell low dosage-80*10^6 cells, Mesenchymal stromal cell low dosage-160*10^6 cells, Placebo-storage solution
NCT07782216 recruitingnot on this mapstarted 2026, after this paper: background citation

Investigating the Significance of Protein Biomarkers During the Hyperacute Phase of Traumatic Brain Injury and Other CNS Conditions With Hypoxia/Hypoperfusion in Emergency and Prehospital Settings (CHARON)

TypeobservationalSponsorUniversity of PecsRan2026 to 2028Enrolled477ConditionsBrain Injuries, Traumatic, Brain Injuries, Acute, Hypoxia, Brain, Cardiac Arrest (CA)
3 · Its place in the literature

Who cites it

161 citing papers in PubMed, 9 syntheses or guidelines pooled it, 274 citations in OpenAlex.

  1. Pooled it
  2. Accuracy of GFAP and UCH-L1 in predicting brain abnormalities on CT scans after mild traumatic brain injury: a systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025
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  10. Trial
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  16. Observational
  17. Blood-based biomarkers GFAP/UCH-L1 for the diagnosis of mild traumatic brain injury (mTBI): a single-center implementation experience.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
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  18. Observational
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101 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 9 institutions in 6 countries.

Endre CzeiterDepartment of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Rét u. 2, H-7623 Pécs, Hungary. Electronic address: endre.czeiter@gmail.com.
Krisztina AmreinDepartment of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary.
Benjamin Y GravesteijnCenter for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands.
Fiona LeckyCentre for Urgent and emergency care REsearch (CURE), Health Services Research Section, School of Health and Related Research (ScHARR), University of Sheffield, S1 4DA, UK; Emergency Department, Salford Royal Hospital, Stott Ln, Salford M6 8HD, UK.
David K MenonDivision of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
Stefania MondelloDepartment of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria n. 1, 98125 Messina, Italy.
Virginia F J NewcombeDivision of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
Sophie RichterDivision of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
Ewout W SteyerbergCenter for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands.
Thijs Vande VyvereResearch and Development, Icometrix, Kolonel Begaultlaan 1b/12, 3012 Leuven, Belgium; Department of Radiology, Antwerp University Hospital and University of Antwerp, Wijlrijkstraat 10, 2650 Edegem, Belgium.
Jan VerheydenResearch and Development, Icometrix, Kolonel Begaultlaan 1b/12, 3012 Leuven, Belgium.
Haiyan XuProgram for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA.
Zhihui YangProgram for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA.
Andrew I R MaasDepartment of Neurosurgery, Antwerp University Hospital and University of Antwerp, Wijlrijkstraat 10, 2650 Edegem, Belgium.
Kevin K W WangProgram for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA; Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center (VAMC), 1601 SW Archer Rd. Gainesville, FL 32608, USA.
András BükiDepartment of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary.
CENTER-TBI Participants and Investigators
University of Cambridge · GBUniversity of Florida · USUniversity of Pecs · HUUniversity of Antwerp · BEErasmus MC · NLIcometrix (Belgium) · BELeiden University Medical Center · NLSalford Royal Hospital · GBUniversity of Messina · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSerum biomarkers may inform and improve care in traumatic brain injury (TBI). We aimed to correlate serum biomarkers with clinical severity, care path and imaging abnormalities in TBI, and explore their incremental value over clinical characteristics in predicting computed tomographic (CT) abnormalities.

methodsWe analyzed six serum biomarkers (S100B, NSE, GFAP, UCH-L1, NFL and t-tau) obtained <24 h post-injury from 2867 patients with any severity of TBI in the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) Core Study, a prospective, multicenter, cohort study. Univariable and multivariable logistic regression analyses were performed. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals.

findingsAll biomarkers scaled with clinical severity and care path (ER only, ward admission, or ICU), and with presence of CT abnormalities. GFAP achieved the highest discrimination for predicting CT abnormalities (AUC 0•89 [95%CI: 0•87-0•90]), with a 99% likelihood of better discriminating CT-positive patients than clinical characteristics used in contemporary decision rules. In patients with mild TBI, GFAP also showed incremental diagnostic value: discrimination increased from 0•84 [95%CI: 0•83-0•86] to 0•89 [95%CI: 0•87-0•90] when GFAP was included. Results were consistent across strata, and injury severity. Combinations of biomarkers did not improve discrimination compared to GFAP alone.

interpretationCurrently available biomarkers reflect injury severity, and serum GFAP, measured within 24 h after injury, outperforms clinical characteristics in predicting CT abnormalities. Our results support the further development of serum GFAP assays towards implementation in clinical practice, for which robust clinical assay platforms are required.

fundingCENTER-TBI study was supported by the European Union 7th Framework program (EC grant 602150).

Indexed as

AgedAged, 80 and overArea Under CurveBiomarkersBrain Injuries, TraumaticFemaleGlial Fibrillary Acidic ProteinHumansMaleNeurofilament ProteinsPatient AdmissionPatient Care PlanningProspective StudiesROC CurveS100 Calcium Binding Protein beta SubunitSeverity of Illness IndexBiomarkersGFAP protein, humanGlial Fibrillary Acidic ProteinMAPT protein, humanneurofilament protein LNeurofilament ProteinsS100B protein, humanS100 Calcium Binding Protein beta Subunittau ProteinsUbiquitin ThiolesteraseUCHL1 protein, humanBiomarkersClinical decision ruleComputerized tomographyDiagnosticGFAPInjury severitySerumTraumatic brain injury

Identifiers

PMID32464528
PMCPMC7251365
OpenAlexW3026371551

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.