{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T15:26:26Z","timestamp":1793978786336,"version":"4.8.0"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The authors sought to identify plasma glial fibrillary acidic protein (GFAP) and ubiquitin c-terminal hydrolase-L1 (UCH-L1) cutoffs corresponding to a range of high positive predictive values (PPVs) for detecting intracranial pathology on CT and detecting pathology on MRI (when CT is negative) in patients who present to a level I trauma center for TBI evaluation with Glasgow Coma Scale (GCS) scores of 13\u201315.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This is a secondary analysis of prospectively collected data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, which is a longitudinal, observational study of patients with TBI who presented to one of 18 US level I trauma centers within 24 hours of injury. Blood samples were collected within 24 hours. Plasma samples were analyzed for GFAP (pg\/mL) and UCH-L1 (pg\/mL). The CT or MRI scan was considered positive (CT+, MRI+) if there was evidence of acute intracranial pathology related to TBI. Receiver operating characteristic curve analysis (AUC) was performed to evaluate the ability of day-1 GFAP and UCH-L1 to discriminate CT+ versus CT\u2212, and CT\u2212\/MRI+ versus CT\u2212\/MRI\u2212. A K-fold cross-validation procedure was used to identify GFAP cutoffs for predicting CT+ among patients with GCS scores of 13\u201315 and for predicting MRI+ among patients with GCS scores of 13\u201315 and CT\u2212 subjects, based on the adjusted PPV thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among the 1718 TBI participants with GCS scores 13\u201315, 633 (37%) had CT+ findings. Of the 1085 CT\u2212 participants, 608 underwent MRI at 2 weeks postinjury, of whom 154 (25%) had MRI+ findings. Day-1 GFAP had an area under the curve (AUC) of 0.82 (95% CI 0.80\u20130.84), and UCH-L1 had an AUC of 0.60 (95% CI 0.57\u20130.63) for discriminating CT+ from CT\u2212. Day-1 GFAP had an AUC of 0.76 (95% CI 0.71\u20130.81) while UCH-L1 had an AUC of 0.60 (95% CI 0.55\u20130.65) for discriminating CT\u2212\/MRI+ from CT\u2212\/MRI\u2212. For CT+ prediction, assuming a prevalence of 0.36 (from our data) and 0.1 (from the literature), the median GFAP cutoffs to achieve an adjusted PPV of 0.9 were 2879 (95% CI 2195\u20134704) and 5191 (95% CI 3779\u20135426), respectively. For MRI+ prediction among GCS 13\u201315 CT\u2212 patients, the median GFAP cutoffs were 1382 (95% CI 1145\u20132424) to achieve an adjusted PPV of 0.9 and 2317 pg\/mL (95% CI 1262\u20132551 pg\/mL) to achieve an adjusted PPV of 0.98.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>These threshold values can be used as an aid-in-diagnosis tool and assist in appropriate triaging of patients who have sustained TBI to urgent neuroimaging, potential escalation in care, and interventions as clinically indicated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.3.jns252691","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:01:18Z","timestamp":1792540878000},"page":"1-8","source":"Crossref","is-referenced-by-count":0,"title":["Clinical cutoffs for plasma biomarkers to identify intracranial pathology in traumatic brain injury patients with Glasgow Coma Scale scores 13 to 15: a TRACK-TBI study"],"prefix":"10.3171","author":[{"given":"Shawn R.","family":"Eagle","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"},{"name":"Weill Institute for Neurosciences, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava M.","family":"Puccio","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon","family":"Diaz-Arrastia","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Bazarian","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Rochester, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick K.","family":"Korley","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin K. W.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurobiology, Morehouse School of Medicine, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firas H.","family":"Kobeissy","sequence":"additional","affiliation":[{"name":"Department of Neurobiology, Morehouse School of Medicine, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"McCrea","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Sun","sequence":"additional","affiliation":[{"name":"Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Jain","sequence":"additional","affiliation":[{"name":"Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey T.","family":"Manley","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco;"},{"name":"Weill Institute for Neurosciences, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Christine","family":"Duhaime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Gardner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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