Medico-Legal Importance of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 in Traumatic Brain Injuries: Prospective Study

Abstract Traumatic brain injuries are one of the most common causes of lifelong disability and violent death (Refaat et al., 2019). Since several complications may occur after traumatic brain injuries, some of them are fatal. So, the allegation of negligence may be common. The patient relatives may claim that death is the result of improper management of treating medical team rather than the unavoidable complications (El- Sarnagawy et al., 2018). Objectives The present study was designed to investigate the medico legal importance of serum GFAP and UCHL-1 as predictive biomarkers of outcome and evaluation of medical care in mild and moderate TBIs to ascertain malpractice claims. Subjects and Methods The present study was carried out on 60 admitted cases with mild and moderate traumatic brain injuries in neurosurgery department, Ain Shams University Hospitals in the period between March2021 to Febraury2022. Serum level of GFAP and UCHL-1 was measured within 12 hours after traumatic brain injuries. Results Males cases were more predominant than females. Age group (18-25 years) represents the most common group subjected to TBIs while age group (>61 years) was the least common among the studied cases. Road traffic accidents were the most frequent cause of traumatic brain injuries while firearm was the least frequent among the studied cases. There was a high significant increase in serum UCHL-1 levels in moderate TBIs cases in comparison to that in mild TBIs cases with 95% and 90% sensitivity and 95% and 75% specificity respectively. Also, there was a high significant increase in serum GFAP and UCHL-1 level in diffuse brain lesions than focal lesions seen in CT scan of the studied cases with TBIs with 78.95% and 89.46% sensitivity and 100% and 91.43% specificity respectively. The combination of GFAP and UCHL-1 increased the sensitivity to 94.74% and specificity to 97.14%. Conclusion The accuracy of serum GFAP alone was greater than accuracy of measurement of both biomarkers, the accuracy of combination of all variables was slightly better than the accuracy of serum GFAP alone as predicators of unfavorable outcome. So, depending on serum GFAP alone instead of combination of all variables didn’t change the sensitivity, specificity and accuracy of predication of unfavorable outcome obviously.