Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathological conditions are highly heterogenous. 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. 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® (Abbott) device (duration of analysis 15 min) shortly after hospital admission. 143 patients were enrolled (mean age 65 ± 20 years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (n = 51) compared to all other coma etiologies (3352 pg/mL [IQR 613–10001] vs. 43 pg/mL [IQR 29–91.25], p < 0.001). When using an optimal cut-off value of 101 pg/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. 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.

中文翻译：

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GFAP 现场测量用于急性昏迷颅内出血的院前诊断

由于潜在的病理状况高度异质性，急性昏迷患者的院前分诊和治疗对于救援服务来说具有挑战性。最近，胶质纤维酸性蛋白（GFAP）已被确定为颅内出血的生物标志物。这项前瞻性研究的目的是测试院前护理点设备上的 GFAP 测量是否有可能快速区分颅内出血和其他原因引起的急性昏迷。这项研究是在德国斯图加特北部附近的 RKH Klinikum Ludwigsburg 一家三级护理医院进行的。前瞻性入组入院前诊断为急性昏迷（格拉斯哥昏迷量表评分在 3 至 8 之间）的患者。在院前阶段收集血样。入院后不久，在 i-STAT Alinity® (Abbott) 设备上进行血浆 GFAP 测量（分析持续时间 15 分钟）。共有 143 名患者入组（平均年龄 65 ± 20 岁，42.7% 为女性）。与所有其他昏迷病因相比，颅内出血患者 (n = 51) 的 GFAP 血浆浓度显着升高（3352 pg/mL [IQR 613–10001] vs. 43 pg/mL [IQR 29–91.25]，p < 0.001） 。当使用101 pg/mL的最佳截止值时，识别颅内出血的敏感性为94.1%（特异性78.9%，阳性预测值71.6%，阴性预测值95.9%）。院内死亡风险与院前 GFAP 值相关。急性昏迷患者血浆中 GFAP 浓度升高可识别颅内出血，具有较高的诊断准确性。现场护理平台上的院前 GFAP 测量可以根据救援服务造成昏迷的根本原因进行快速分层。这可能会对这些危重患者的分诊和管理产生重大影响。