Neuroanaesthesia & neurocritical care
Prehospital Point-of-Care Glial Fibrillary Acidic Protein (GFAP) for Detection of Intracranial Hemorrhage in Acute Nontraumatic Coma
Authors' conclusion
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.
Study context
- Population
- Adult patients (aged ≥16 years) presenting with acute nontraumatic coma (Glasgow Coma Scale score of 12 or less) who underwent prehospital rapid sequence induction (RSI) of anesthesia with clinical suspicion of ICH, UK physician-paramedic helicopter emergency medical service, January 1, 2025, to April 30, 2026primary study cohort who underwent prehospital brain biomarker testing
- Participants
- 65 patients
- Comparison
- Prehospital point-of-care GFAP and UCH-L1 for detecting ICH, using computed tomography as the reference standard
- Outcome
- Diagnostic accuracy of GFAP and UCH-L1 for detecting ICH (computed tomography reference standard)
Methodological detailsconsecutive sample, prehospital, physician-paramedic helicopter emergency medical service
- Consecutive sample
- Prehospital
- Physician-paramedic helicopter emergency medical service
Performance
As reported in the abstract
| Test or model | Sensitivity | AUC | Specificity | Discriminatory performance | Negative predictive value |
|---|---|---|---|---|---|
| GFAP | 97.0% (95% CI, 84.2%-99.9%) | 0.94 (95% CI, 0.87-0.99) | |||
| UCH-L1 | 78.8% (95% CI, 61.1%-91.0%) | 18.8% (95% CI, 7.2%-36.4%) | limited | ||
| Combined biomarker approach | 100.0% (95% CI, 89.4%-100.0%) | 100.0% (95% CI, 47.8%-100.0%) |
Sensitivity
GFAP97.0% (95% CI, 84.2%-99.9%)
UCH-L178.8% (95% CI, 61.1%-91.0%)
Combined biomarker approach100.0% (95% CI, 89.4%-100.0%)
AUC
GFAP0.94 (95% CI, 0.87-0.99)
UCH-L1— not stated in the abstract
Combined biomarker approach— not stated in the abstract
Specificity
GFAP— not stated in the abstract
UCH-L118.8% (95% CI, 7.2%-36.4%)
Combined biomarker approach— not stated in the abstract
Discriminatory performance
GFAP— not stated in the abstract
UCH-L1limited
Combined biomarker approach— not stated in the abstract
Negative predictive value
GFAP— not stated in the abstract
UCH-L1— not stated in the abstract
Combined biomarker approach100.0% (95% CI, 47.8%-100.0%)
Further findings
Cohort characteristics and course
- Median age
- 63 [IQR, 47-69] years
- Male
- 55.4%
- Median (IQR) Glasgow Coma Scale (GCS) score
- 4 (3-6)
- ICH present
- 50.8% (n = 33)
- Underwent neurosurgery
- Thirteen (20.0%)
- 30-day survival rate
- 46.2% (n = 30)
Original publication
Prehospital Point-of-Care GFAP for Detection of Intracranial Hemorrhage in Acute Nontraumatic Coma. JAMA Netw Open. Published 1 October 2026. doi:10.
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