RESUMEN
Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-terminal hydrolase (UCH-L1) have been FDA-approved for clinical use in mild and moderate traumatic brain injury (TBI). Understanding sex differences in their diagnostic accuracy over time will help inform clinical practice. We sought to evaluate the sex differences in the temporal profile of GFAP and UCH-L1 in a large cohort of trauma patients presenting to the emergency department. To compare the biomarkers' diagnostic accuracy in male versus female patients for detecting mild TBI (MTBI), and traumatic intracranial lesions on head CT. This prospective cohort study enrolled female and male adult trauma patients presenting to a Level 1 Trauma Center. All patients underwent rigorous screening to determine whether or not they had experienced a MTBI. Of 3025 trauma patients assessed, 1030 met eligibility criteria and 446 declined. Initial blood samples were obtained in 584 patients enrolled within 4 h of injury. Repeated blood sampling was conducted at 4, 8, 12, 16, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144, 156, 168, and 180-h post-injury. The main outcomes included the diagnostic accuracy in detection of MTBI and traumatic intracranial lesions on head CT scan. A total of 1831 samples were drawn in 584 patients over 7 days, 362 (62%) were male and 222 (38%) were female. The pattern of elevation was similar in both sexes. Although the pattern of elevation was similar between male and female for both biomarkers, male patients had significantly higher concentrations of UCH-L1 compared to female patients at several timepoints post-injury, particularly within 24 h of injury. There were no significant differences in diagnostic accuracy for detecting MTBI or for detecting CT lesions between male and female patients at any timepoint for both GFAP and UCH-L1. Although patterns of GFAP and UCH-L1 release in trauma patients over a week post-injury was similar between the sexes, there were significantly higher concentrations of UCH-L1 in males at several timepoints post-injury. Despite this, the overall diagnostic accuracies of both GFAP and UCH-L1 over time for detecting MTBI and CT lesions were not significantly different between male and female trauma patients.
Asunto(s)
Conmoción Encefálica , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Adolescente , Anciano , Anciano de 80 o más Años , Caracteres Sexuales , Conmoción Encefálica/diagnóstico , BiomarcadoresRESUMEN
BACKGROUND: In recent years, several states have enacted Stand Your Ground (SYG) legislation intended to deter crime. To date, the impact of these laws on justifiable homicide (JH) and homicide (HOM) is unknown. This study was designed to compare JH and HOM rates (JHR, HR) before and after enactment of SYG laws and in states with and without (NoSYG) such legislation. STUDY DESIGN: This was a retrospective analysis of justifiable homicide and homicide using 3 United States datasets from 2000 to 2017. Descriptive statistics and univariate linear regressions were used to evaluate the association of SYG laws and JH and HOM in the United States. RESULTS: There were 4,594 incidents of JH and 214,630 incidents of HOM in the United States between 2000 and 2017. Stand Your Ground states accounted for most JH and HOM incidents 3,184 (69%) and 116,511 (54%), respectively. Stand Your Ground states had higher JH and HOM rates than NoSYG states (0.126 vs 0.047 and 4.663 vs 3.301 per 100,000 population, respectively; p < 0.001). Comparing periods pre- (2000 to 2004) and post-SYG (2005 to 2017) law enactment, SYG vs NoSYG states had increased JH rates of 54.9% vs 20.4%, respectively (p < 0.001); HOM rates increased 10.8% in SYG states and decreased 2.3% in NoSYG states (p < 0.001). CONCLUSIONS: Stand Your Ground states had significantly higher JH and HOM rates and significantly greater increases in JH and HOM rates pre- vs post-SYG law enactment compared with NoSYG states. These results raise questions about the potential adverse consequences of policies such as the SYG law in the US.