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Recently, glial fibrillary acidic protein (GFAP) has been identified as a biomarker of intracranial hemorrhage. The aim of this prospective study was to test whether prehospital GFAP measurements on a point-of-care device have the potential to rapidly differentiate intracranial hemorrhage from other causes of acute coma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in the northern vicinity of Stuttgart, Germany. Patients who were admitted to the emergency department with the prehospital diagnosis of acute coma (Glasgow Coma Scale scores between 3 and 8) were enrolled prospectively. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity\u00ae (Abbott) device (duration of analysis 15\u00a0min) shortly after hospital admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      143 patients were enrolled (mean age 65\u2009\u00b1\u200920\u00a0years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200951) compared to all other coma etiologies (3352\u00a0pg\/mL [IQR 613\u201310001] vs. 43\u00a0pg\/mL [IQR 29\u201391.25],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). When using an optimal cut-off value of 101\u00a0pg\/mL, sensitivity for identifying intracranial hemorrhage was 94.1% (specificity 78.9%, positive predictive value 71.6%, negative predictive value 95.9%). In-hospital mortality risk was associated with prehospital GFAP values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increased GFAP plasma concentrations in patients with acute coma identify intracranial hemorrhage with high diagnostic accuracy. Prehospital GFAP measurements on a point-of-care platform allow rapid stratification according to the underlying cause of coma by rescue services. This could have major impact on triage and management of these critically ill patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s13054-024-04892-5","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T04:02:01Z","timestamp":1712289721000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma"],"prefix":"10.1186","volume":"28","author":[{"given":"Sabina","family":"Zylyftari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Luger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristaps","family":"Blums","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Barthelmes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Humm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannsj\u00f6rg","family":"Baum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Meckel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Braun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Lichy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Heilgeist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Love-Preet","family":"Kalra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Foerch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"4892_CR1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s12871-015-0041-9","volume":"15","author":"MWB Horsting","year":"2015","unstructured":"Horsting MWB, Franken MD, Meulenbelt J, van Klei WA, de Lange DW. 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Written informed consent to participate was obtained from all surviving\u00a0patients\u00a0or their\u00a0legal representatives before ultimate inclusion into the study. As per study protocol, before obtaining informed consent, an aliquot of the blood sample drawn in the prehospital phase for routine diagnostic purposes was taken for study purposes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of anonymized patient data was obtained from all surviving\u00a0patients\u00a0or their\u00a0legal representatives before publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Prof. Foerch invented the following patent: Use of GFAP for identification of intracerebral hemorrhage (US20150247867). The other authors report no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"109"}}