Performance of glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) biomarkers in predicting CT scan results and neurological outcomes in children with traumatic brain injury (BRAINI-2 paediatric study): protocol of a European prospective multicentre study

Abstract

Lesió neurològica; Urgències pediàtriques; Gestió del trauma

Lesión neurológica; Urgencias pediátricas; Manejo del trauma

Neurological injury; Paediatric emergencies; Trauma management

Introduction In light of the burden of traumatic brain injury (TBI) in children and the excessive number of unnecessary CT scans still being performed, new strategies are needed to limit their use while minimising the risk of delayed diagnosis of intracranial lesions (ICLs). Identifying children at higher risk of poor outcomes would enable them to be better monitored. The use of the blood-based brain biomarkers glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1) could help clinicians in this decision. The overall aim of this study is to provide new knowledge regarding GFAP and UCH-L1 in order to improve TBI management in the paediatric population. Methods and analysis We will conduct a European, prospective, multicentre study, the BRAINI-2 paediatric study, in 20 centres in France, Spain and Switzerland with an inclusion period of 30 months for a total of 2880 children and adolescents included. To assess the performance of GFAP and UCH-L1 used separately and in combination to predict ICLs on CT scans (primary objective), 630 children less than 18 years of age with mild TBI, defined by a Glasgow Coma Scale score of 13–15 and with a CT scan will be recruited. To evaluate the potential of GFAP and UCH-L1 in predicting the prognosis after TBI (secondary objective), a further 1720 children with mild TBI but no CT scan as well as 130 children with moderate or severe TBI will be recruited. Finally, to establish age-specific reference values for GFAP and UCH-L1 (secondary objective), we will include 400 children and adolescents with no history of TBI. Ethics and dissemination This study has received ethics approval in all participating countries. Results from our study will be disseminated in international peer-reviewed journals. All procedures were developed in order to assure data protection and confidentiality.

This study is supported by a grant from the European Institute of Innovation and Technology (EIT) Health Program of the European Union (Innovation Proposals 2022). Each academic partner (Nantes University Hospital, Nantes, France; Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio Madrileno de Salud-SERMAS, Madrid, Spain; Hospital Universitario Vall d’Hebron, Barcelona, Spain; Kantonsspital, Luzern, Switzerland; and TUM Klinikum, Munich, Germany) as well as bioMérieux (Marcy l’Etoile, France) will participate in the co-funding of the study, according to EIT Health rules. BioMérieux has developed and manufactures the VIDAS TBI assay and will perform the biomarker measurements required for the study. As a study sponsor, the Nantes University Hospital has taken out an insurance policy covering the financial consequences of its civil liability in compliance with the regulations.