{
  "abstract": "ImportanceThere is an urgent need for objective blood tests to guide triage of suspected traumatic brain injury (TBI) in far-forward combat environments, where blast exposure is common and neuroimaging is frequently unavailable. Blood-based glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) are transforming triage of suspected TBI due to their 99% negative predictive value for ruling out acute intracranial trauma in civilian impact TBI. However, accuracy in military blast-dominant TBI is unclear.\n\nObjectiveTo determine accuracy of day-of-injury serum or plasma GFAP and UCH-L1 levels for ruling-out acute intracranial trauma in a sequential real-world cohort of combat casualties.\n\nDesignRetrospective cohort study leveraging existing data from a clinical laboratory validation protocol that processed and stored leftover day-of-injury clinical samples from evacuated combat casualties between January 1, 2024, and February 6, 2025 for subsequent analysis for GFAP and UCH-L1 using FDA-cleared assay thresholds.\n\nSettingSingle-center, tertiary referral trauma center.\n\nParticipantsDay-of-injury plasma or serum GFAP and UCH-L1 levels were available for 137 combat casualties. The cohort was 99.3% male with a median age of 21.8 years; 75.2% sustained blast-related injuries. Most (92.7%) had blood collected within 6 hours of injury.\n\nExposureSerum or plasma GFAP and UCH-L1 measured with Abbott Alinity-i or i-STAT TBI assays. Elevation was defined as GFAP [≥]35 pg/mL or UCH-L1 [≥]400 pg/mL on Alinity-i, and GFAP [≥]30 pg/mL or UCH-L1 [≥]360 pg/mL on i-STAT.\n\nMain Outcomes and MeasuresAccuracy of biomarker elevation for ruling-out intracranial trauma on head CT, including sensitivity, specificity, and negative predictive value (NPV).\n\nResultsAmong 137 casualties, 83 (60.6%) were biomarker-elevated. Sixteen participants (11.7%) had CT-confirmed intracranial trauma, of whom 15 were biomarker-elevated, yielding 93.8% sensitivity and 98.2% NPV, and 43.8% specificity. Twenty-three participants (16.8%) had intracranial trauma and/or head/face/c-spine fracture; 21 were biomarker-elevated, corresponding to 91.3% sensitivity, 96.3% NPV, and 45.6% specificity.\n\nConclusions and RelevanceIn this real-world cohort of blast-dominant combat casualties, day-of-injury GFAP and UCH-L1 demonstrated high NPV and sensitivity for intracranial trauma, with modest specificity. These findings support the utility of GFAP and UCH-L1 to aid early triage and decision-making in blast-dominant military TBI.",
  "abstract_shown": true,
  "affiliations": [
    "Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "A. Sheldon"
    },
    {
      "name": "Y. Rosen Lang"
    },
    {
      "name": "A. Perry"
    },
    {
      "name": "A. Peled"
    },
    {
      "name": "R. Hershkovitch"
    },
    {
      "name": "G. Rosenthal"
    },
    {
      "name": "K. Asraf"
    },
    {
      "name": "C. Moskovitz"
    },
    {
      "name": "R. Doolman"
    },
    {
      "name": "D. Dominissini"
    },
    {
      "name": "Y. Klein"
    },
    {
      "name": "A. Ironi"
    },
    {
      "name": "A. Epstein"
    },
    {
      "name": "G. Manley"
    },
    {
      "name": "S. Shapira"
    },
    {
      "name": "R. C. Gardner"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1rwzt8t14jd91.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.06.26364753",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364753v1.full",
  "id": "1rwzt8t14jd91",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364753v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "neurology"
    ],
    [
      "openalex",
      "2713|Traumatic Brain Injury Research"
    ]
  ],
  "openalex": "W7221044713",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364753v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/1rwzt8t14jd91.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:20Z",
      "native_id": "10.64898/2026.10.06.26364753",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364753v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:neurology",
      "subfield": "neurology"
    }
  ],
  "title": "Diagnostic Accuracy of GFAP and UCH-L1 for Acute Intracranial Trauma in a Predominantly Blast-Exposed Cohort of Combat Casualties",
  "title_text": "Diagnostic Accuracy of GFAP and UCH-L1 for Acute Intracranial Trauma in a Predominantly Blast-Exposed Cohort of Combat Casualties",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:20Z",
  "url": "https://research.draconitic.com/paper/1rwzt8t14jd91",
  "venue": "medRxiv",
  "versions": []
}