Original Title: Biomarkörer som stöd inför beslut om datortomografi vid lätt huvudskada hos vuxna: En systematisk översikt och utvärdering av medicinska, hälsoekonomiska, etiska och organisatoriska aspekter

Authors' objectives: The objective of this report is to assess the ability of the biomarkers S100B, GFAP, UCHL-1, and NF-L to exclude trauma-related findings on CT in adult patients with mild head injury and to evaluate if biomarker analysis in blood can safely reduce CT usage. Additionally, to examine the health economic impact of adopting biomarker analysis compared to current practices.

Authors' results and conclusions: Key Message • Analysis of S100B, GFAP, or the combination of GFAP and UCH-L1 in blood demonstrates equally good ability to identify adult patients with trauma-related findings on CT. The scientific certainty, according to GRADE, is moderate for GFAP and the combination of GFAP+UCH-L1, and low for S100B. For UCH-L1 alone, the scientific evidence is too limited to draw any conclusions. • In a hypothetical group of 1000 patients with mild head injury and an expected ten percent presence of trauma-related findings on CT, the number of missed injuries corresponds to two patients for GFAP, three patients for GFAP+UCH-L1, and four patients for S100B. • The need for CT could probably be reduced by approximately 30 percent if analysis of GFAP, GFAP+UCH-L1, or S100B is used in the assessment of patients with mild head injury. • Model-based health economic cost analyses indicate that biomarkers may be cost-saving. Results are sensitive to price of biomarker tests and unit costs of computed tomography. 3 (120)

Authors' methods: A systematic search of articles in several databases was conducted in May 2025 and repeated in November 2025. Selected studies were assessed at abstract and full-text levels by at least two independent authors, with inclusion decisions made by consensus. The studies underwent critical appraisal, and relevant data were extracted. A meta-analysis was performed to assess the ability of the biomarkers S100B, GFAP, UCH-L1, and the combination GFAP+UCH-L1 to correctly identify patients without changes on CT. Data on the number of false-negative results, where the biomarker analysis incorrectly indicated no changes on CT, were collected when available. The certainty of the results was evaluated using the GRADE approach. Articles with health economic analyses were evaluated by a health economist.

Project Status: Completed

Year Published: 2026

URL for published report: https://vardgivare.skane.se/siteassets/3.-kompetens-och-utveckling/sakkunniggrupper/hta/rapporter/2026/biomarkorer-som-stod-infor-beslut-om-datortomografi-vid-latt-huvudskada-hos-vuxna.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Sweden

Organisation Name: HTA South

Contact Address: Skåne University Hospital, Lund

Contact Name: hta.syd@skane.se

Contact Email: hta.syd@skane.se