{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:45:24Z","timestamp":1792079124336,"version":"4.4.0"},"reference-count":14,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Rapid identification of intracranial hemorrhage (ICH) in patients with acute nontraumatic coma is critical to guiding triage and early management; however, prehospital diagnostic tools remain limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the diagnostic accuracy of prehospital whole-blood point-of-care measurement of glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) for detecting ICH.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This diagnostic study used data collected by a UK physician-paramedic helicopter emergency medical service between January 1, 2025, and April 30, 2026. A consecutive sample of adult patients (aged \u226516 years) presenting with acute nontraumatic coma, defined as Glasgow Coma Scale (GCS) score of 12 or less, who underwent prehospital rapid sequence induction (RSI) of anesthesia with clinical suspicion of ICH were eligible for inclusion. Patients with traumatic pathology and those without follow-up data were excluded. Patients were observed for up for 30 days from hospital admission. Data analysis was performed in June 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Prehospital whole-blood point-of-care brain biomarker (GFAP and UCH-L1) testing using the i-STAT Alinity Point-of-Care Blood Analyzer (Abbott Laboratories).<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n Diagnostic accuracy of GFAP and UCH-L1 for detecting ICH, using computed tomography as the reference standard. Sensitivity, specificity, predictive value, and area under the receiver operating characteristic curve (AUC) were calculated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The primary study cohort comprised 65 patients who underwent prehospital brain biomarker testing (median age, 63 [IQR, 47-69] years; 55.4% male). The median (IQR) GCS score was 4 (3-6). ICH was present in 50.8% (n\u2009=\u200933). Thirteen (20.0%) patients underwent neurosurgery, and the 30-day survival rate was 46.2% (n\u2009=\u200930). GFAP demonstrated high sensitivity (97.0%; 95% CI, 84.2%-99.9%) and discriminatory ability (AUC, 0.94; 95% CI, 0.87-0.99). UCH-L1 showed lower sensitivity (78.8%; 95% CI, 61.1%-91.0%) and specificity (18.8%; 95% CI, 7.2%-36.4%), with limited discriminatory performance. A combined biomarker approach achieved 100.0% sensitivity (95% CI, 89.4%-100.0%) and a negative predictive value of 100.0% (95% CI, 47.8%-100.0%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this diagnostic study of adults with acute nontraumatic coma undergoing prehospital RSI, point-of-care prehospital GFAP testing was feasible and demonstrated high diagnostic accuracy in detecting intracranial hemorrhage. Further prospective external validation is required to determine its association with triage, treatment decisions, and patient outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.39337","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:00:30Z","timestamp":1792076430000},"page":"e2639337","source":"Crossref","is-referenced-by-count":0,"title":["Prehospital Point-of-Care GFAP for Detection of Intracranial Hemorrhage in Acute Nontraumatic Coma"],"prefix":"10.1001","volume":"9","author":[{"given":"James","family":"Price","sequence":"first","affiliation":[{"name":"Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK"},{"name":"Emergency and Urgent Care Research in Cambridge, Perioperative, Acute, Critical Care and Emergency Medicine (PACE) Section, Department of Medicine, Cambridge University, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Lachowycz","sequence":"additional","affiliation":[{"name":"Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Palti","sequence":"additional","affiliation":[{"name":"Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Major","sequence":"additional","affiliation":[{"name":"Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Zylyftari","sequence":"additional","affiliation":[{"name":"RKH Klinikum Ludwigsburg, Ludwigsburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Foerch","sequence":"additional","affiliation":[{"name":"RKH Klinikum Ludwigsburg, Ludwigsburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed B. G.","family":"Barnard","sequence":"additional","affiliation":[{"name":"Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK"},{"name":"Emergency and Urgent Care Research in Cambridge, Perioperative, Acute, Critical Care and Emergency Medicine (PACE) Section, Department of Medicine, Cambridge University, Cambridge, UK"},{"name":"Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"1","key":"zoi261064r1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s12871-015-0041-9","article-title":"The etiology and outcome of non-traumatic coma in critical care: a systematic review.","volume":"15","author":"Horsting","year":"2015","journal-title":"BMC Anesthesiol"},{"issue":"9959","key":"zoi261064r2","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1016\/S0140-6736(13)62184-4","article-title":"Diagnosis of reversible causes of coma.","volume":"384","author":"Edlow","year":"2014","journal-title":"Lancet"},{"issue":"7","key":"zoi261064r3","doi-asserted-by":"publisher","first-page":"e282","DOI":"10.1161\/STR.0000000000000407","article-title":"2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association\/American Stroke Association.","volume":"53","author":"Greenberg","year":"2022","journal-title":"Stroke"},{"issue":"10","key":"zoi261064r4","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1001\/jamaneurol.2022.2456","article-title":"Association of neurocritical care services with mortality and functional outcomes for adults with brain injury: a systematic review and meta-analysis.","volume":"79","author":"Pham","year":"2022","journal-title":"JAMA Neurol"},{"issue":"2","key":"zoi261064r5","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1080\/10903127.2018.1501444","article-title":"Quality and feasibility of sonographic measurement of the optic nerve sheath diameter to estimate the risk of raised intracranial pressure after traumatic brain injury in prehospital setting.","volume":"23","author":"Houz\u00e9-Cerfon","year":"2019","journal-title":"Prehosp Emerg Care"},{"issue":"2","key":"zoi261064r6","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s11940-020-0611-0","article-title":"Mobile stroke units: bringing treatment to the patient.","volume":"22","author":"Ehntholt","year":"2020","journal-title":"Curr Treat Options Neurol"},{"issue":"1","key":"zoi261064r7","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s13054-024-04892-5","article-title":"GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma.","volume":"28","author":"Zylyftari","year":"2024","journal-title":"Crit Care"},{"key":"zoi261064r8","doi-asserted-by":"publisher","first-page":"h5527","DOI":"10.1136\/bmj.h5527","article-title":"STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies.","volume":"351","author":"Bossuyt","year":"2015","journal-title":"BMJ"},{"issue":"11","key":"zoi261064r9","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1136\/emermed-2019-209077","article-title":"End-tidal and arterial carbon dioxide gradient in serious traumatic brain injury after prehospital emergency anaesthesia: a retrospective observational study.","volume":"37","author":"Price","year":"2020","journal-title":"Emerg Med J"},{"issue":"1","key":"zoi261064r10","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s13049-024-01193-2","article-title":"Prehospital invasive arterial blood pressure monitoring in critically ill patients attended by a UK helicopter emergency medical service- a retrospective observational review of practice.","volume":"32","author":"Butterfield","year":"2024","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"7872","key":"zoi261064r11","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/S0140-6736(74)91639-0","article-title":"Assessment of coma and impaired consciousness. 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