Diagnostic accuracy of GFAP and UCH-L1 for intracranial hemorrhage in blunt head trauma: a prospective study

Background: Early and accurate identification of intracranial hemorrhage (ICH) following traumatic brain injury (TBI) is crucial, yet conventional imaging techniques like CT have limitations including radiation exposure and overutilization. This study aimed to evaluate the diagnostic utility of two blood-based biomarkers, Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin Carboxy-Terminal Hydrolase L1 (UCH-L1), in detecting ICH in emergency department patients with blunt head trauma. Methods: This single-center prospective observational study included 442 patients presenting with blunt head trauma at a university emergency department. Plasma GFAP and UCH-L1 levels were measured prior to cranial CT imaging. ROC curve analysis, sensitivity, specificity, and logistic regression were used to assess diagnostic performance and associations between biomarker levels and CT-confirmed ICH. Results: ICH was detected in 6.1% of patients. GFAP and UCH-L1 both demonstrated high diagnostic performance with AUC values of 0.98 and 0.95, respectively. Sensitivity and specificity were 92.6% and 98.8% for GFAP, and 92.6% and 99.0% for UCH-L1. When both biomarkers were concurrently elevated, sensitivity remained at 92.6% with a negative predictive value of 99.5%. Univariate logistic regression revealed strong associations with ICH: GFAP (OR = 1025.0, 95% CI: 189.4–5548.3) and UCH-L1 (OR = 1284.4, 95% CI: 224.4–7352.3), both p < 0.001. Conclusion: GFAP and UCH-L1 are highly sensitive and specific biomarkers for early ICH detection in blunt head trauma. Their combined use may enhance triage accuracy, reduce unnecessary imaging, and support rapid clinical decision-making in emergency settings. Larger multicenter studies are warranted to validate these findings and standardize cut-off values. © The Author(s) 2025.