Relationship Between Time of Hospital Arrival and Clinical and Fluid Biomarker Outcomes in Traumatic Brain Injury (P14-7.003)

Abstract

<h3>Objective:</h3> Identify variables related to delayed emergency department (ED) presentation after traumatic brain injury (TBI). <h3>Background:</h3> Delayed presentation to ED after TBI may differ based on demographic and clinical variables and may confound interpretation of clinical assessments and blood biomarker testing. <h3>Design/Methods:</h3> Patients with non-penetrating TBI were enrolled after admission to an urban trauma center. Time between injury and ED arrival was categorized as &lt;1 hour, 1–6 hours, and &gt;6 hours. Blood was drawn on Day 1, Day 3, 2 weeks, and 6 months post-injury and analyzed using Simoa HD-X Neuro4plex assay for NfL, GFAP, and UCH-L1 levels. Demographic variables and clinical outcomes by arrival time category were assessed with Chi-Square or Kruskal-Wallis tests. For fluid blood-biomarkers, log2 levels were compared between arrival time categories using one-way ANOVA. <h3>Results:</h3> 187 individuals with TBI (mean age 47.7 years, 71% male, 50% white, and median Glasgow Coma Score (GCS) of 15) were included in this analysis. 60% arrived in &lt;1 hour, 24% 1–6 hours, and 11% &gt;6 hours (only 3% presented &gt;24 hours after injury). There were significant differences by arrival time categories by injury mechanism, with 84% motor vehicle incidents presenting within an hour (χ²=27.6, <i>p</i>&lt;0.001). Additionally, younger patients (H=13.6, <i>p</i>=0.001), and Black individuals (χ²=17.2, <i>p</i>=0.002), also were most likely to arrive within an hour. There were no differences in arrival time category by sex, head CT findings, or GCS. For blood-biomarkers, there were no differences between arrival time categories for NfL, UCH-L1, and GFAP. <h3>Conclusions:</h3> Mechanism of injury, age, and race are identifiable factors that may influence both arrival time at ED and clinical outcomes and interpretation of biomarker results after TBI. Since our cohort mostly presented within 12 hours, and CT and biomarker results were not influenced, future research should focus on a small cohort of patients with ED presentation beyond 12 hours. <b>Disclosure:</b> Mr. Anandarajah has nothing to disclose. Alexa Walter has nothing to disclose. Dr. Gugger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ceribell. The institution of Dr. Gugger has received research support from American Epilepsy Society. Cillian Lynch has nothing to disclose. Dr. Schneider has nothing to disclose. The institution of Dr. Sandsmark has received research support from NINDS. Dr. Diaz-Arrastia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ischemix, Inc. Dr. Diaz-Arrastia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pinteon Therapeutics. Dr. Diaz-Arrastia has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BrainBox, LLC. Dr. Diaz-Arrastia has received stock or an ownership interest from BrainBox, LLC. Dr. Diaz-Arrastia has received stock or an ownership interest from NovaSignal . Dr. Diaz-Arrastia has received stock or an ownership interest from Nia Therpeutics. The institution of Dr. Diaz-Arrastia has received research support from National Institutes of Health. The institution of Dr. Diaz-Arrastia has received research support from Department of Defense.