{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T13:33:15Z","timestamp":1771335195638,"version":"3.50.1"},"reference-count":23,"publisher":"Croatian Society for Medical Biochemistry and Laboratory Medicine","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biochem. med. (Online)"],"published-print":{"date-parts":[[2026,2,15]]},"abstract":"<jats:p>Introduction: Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) are increasingly used biomarkers in the evaluation of mild traumatic brain injury (mTBI), primarily to reduce the frequent overuse of head computed tomography (head CT). However, their specificity may be compromised by orthopedic trauma, which commonly accompanies mTBI. The aim of this study was to assess whether orthopedic trauma is associated with higher serum concentrations of GFAP and UCH-L1 in CT-negative mTBI patients, thereby potentially reducing their specificity for detecting CT-positive mTBI.\nMaterials and methods: This prospective observational study included 67 CT-negative mTBI patients, of whom 29 (0.43) had orthopedic trauma and 38 (0.57) had none. Blood samples were obtained within 12 hours of injury and serum concentrations of GFAP and UCH-L1 were measured using a chemiluminescent microparticle immunoassay (CMIA) on the Alinity analyzer, following the manufacturer\u2019s instructions. Statistical analysis included Mann-Whitney U test, chi-square test, Kruskal-Wallis test, post-hoc Dunn\u2019s test and logistic regression analysis with P &lt; 0.05 considered significant.\nResults: Serum GFAP concentrations were significantly higher in patients with orthopedic injuries (median (IQR): 70.0 (30.8 to 226.5) pg\/mL) than in those without (24.95 (5.52 to 49.15) pg\/mL; P &lt; 0.001). Similarly, UCH-L1 concentrations were higher in the orthopedic injury group (median (IQR): 2494.3 (670.1 to 5708.1) pg\/mL) compared with those without trauma (262.8 (153.8-595.3) pg\/mL; P &lt; 0.001).\nConclusions: Orthopedic trauma is associated with higher serum concentrations of GFAP and UCH-L1 in CT-negative mTBI patients, which may reduce the specificity of these biomarkers for ruling out intracranial injury.<\/jats:p>","DOI":"10.11613\/bm.2026.010707","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T08:28:18Z","timestamp":1771316898000},"page":"114-123","source":"Crossref","is-referenced-by-count":0,"title":["Orthopedic trauma is associated with higher serum concentrations of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 in mild traumatic brain injury with negative head computed tomography"],"prefix":"10.11613","volume":"36","author":[{"given":"Alma","family":"Osmi\u0107-Husni","sequence":"first","affiliation":[{"name":"Department for Biochemistry, Polyclinic for Laboratory Diagnostics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radivoj","family":"Jadri\u0107","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4885","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"issue":"43","key":"key20260217082811_r1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/16501960410023877","article-title":"Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.","author":"Carroll","year":"2004","journal-title":"J Rehabil Med"},{"key":"key20260217082811_r2","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1089\/neu.2013.2984","article-title":"Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study.","volume":"31","author":"McMahon","year":"2014","journal-title":"J Neurotrauma"},{"key":"key20260217082811_r3","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1067\/mem.2002.125782","article-title":"Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting.","volume":"40","author":"Jagoda","year":"2002","journal-title":"Ann Emerg Med"},{"key":"key20260217082811_r4","first-page":"483","article-title":"CT overuse for mild traumatic brain injury.","volume":"38","author":"Melnick","year":"2012","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"key20260217082811_r5","article-title":"Comparative efficacy of MRI and CT in traumatic brain injury: a systematic review.","volume":"16","author":"Dabas","year":"2024","journal-title":"Cureus"},{"key":"key20260217082811_r6","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1001\/jamaneurol.2016.0039","article-title":"Time course and diagnostic accuracy of glial and neuronal blood biomarkers GFAP and UCH-L1 in a large cohort of trauma patients with and without mild traumatic brain injury.","volume":"73","author":"Papa","year":"2016","journal-title":"JAMA Neurol"},{"key":"key20260217082811_r7","doi-asserted-by":"crossref","first-page":"R156","DOI":"10.1186\/cc10286","article-title":"Neuronal and glial markers are differently associated with computed tomography findings and outcome in patients with severe traumatic brain injury: a case-control study.","volume":"15","author":"Mondello","year":"2011","journal-title":"Crit Care"},{"key":"key20260217082811_r8","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/S1474-4422(18)30231-X","article-title":"Serum GFAP and UCH-L1 for prediction of absence of intracranial injuries on head CT (ALERT-TBI): a multicentre observational study.","volume":"17","author":"Bazarian","year":"2018","journal-title":"Lancet Neurol"},{"key":"key20260217082811_r9","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s12245-024-00708-z","article-title":"Evaluation of GFAP\/UCH-L1 biomarkers for computed tomography exclusion in mild traumatic brain injury (mTBI).","volume":"17","author":"Legramante","year":"2024","journal-title":"Int J Emerg Med"},{"key":"key20260217082811_r10","unstructured":"Abbott Laboratories. Alinity i GFAP and UCH-L1 assay package insert. Available at: https:\/\/www.corelaboratory.abbott. Accessed July 23rd 2025."},{"key":"key20260217082811_r11","doi-asserted-by":"crossref","first-page":"319","DOI":"10.3390\/bios11090319","article-title":"The current state of traumatic brain injury biomarker measurement methods.","volume":"11","author":"Krausz","year":"2021","journal-title":"Biosensors (Basel)"},{"key":"key20260217082811_r12","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s00068-024-02697-3","article-title":"Accuracy of GFAP and UCH-L1 in predicting brain abnormalities on CT scans after mild traumatic brain injury: a systematic review and meta-analysis.","volume":"51","author":"Karamian","year":"2025","journal-title":"Eur J Trauma Emerg Surg"},{"key":"key20260217082811_r13","doi-asserted-by":"crossref","DOI":"10.12659\/MSM.948353","article-title":"GFAP\/UCH-L1 as a biomarker for rapid assessment of mild TBI in emergency departments.","volume":"31","author":"Jalali","year":"2025","journal-title":"Med Sci Monit"},{"key":"key20260217082811_r14","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/MEJ.0000000000001234","article-title":"Exclusion of intracranial lesions in mild traumatic brain injury using glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1: a European multicenter study.","volume":"32","author":"Milevoj Kop\u010dinovi\u0107","year":"2025","journal-title":"Eur J Emerg Med"},{"key":"key20260217082811_r15","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1089\/neu.2016.4442","article-title":"Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 are not specific biomarkers for mild CT-negative traumatic brain injury.","volume":"34","author":"Posti","year":"2017","journal-title":"J Neurotrauma"},{"key":"key20260217082811_r16","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1089\/neu.2013.3245","article-title":"GFAP out-performs S100\u03b2 in detecting traumatic intracranial lesions on computed tomography in 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Neurotrauma"},{"key":"key20260217082811_r19","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0140-6736(74)91639-0","article-title":"Assessment of coma and impaired consciousness: a practical scale.","volume":"2","author":"Teasdale","year":"1974","journal-title":"Lancet"},{"key":"key20260217082811_r20","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/00001199-199309000-00009","article-title":"Definition of mild traumatic brain injury.","volume":"8","author":"Kay","year":"1993","journal-title":"J Head Trauma Rehabil"},{"key":"key20260217082811_r21","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/BF01148114","article-title":"Molecular identity, distribution and heterogeneity of glial fibrillary acidic protein: an immunoblotting and immunohistochemical study of Schwann cells, satellite cells, enteric glia and astrocytes.","volume":"13","author":"Jessen","year":"1984","journal-title":"J 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