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Serum biomarker concentrations and outcome after pediatric traumatic brain injury
Rachel Pardes Berger1, Sue R Beers, Rudolph Richichi
1Department of Pediatrics, Division of Child Advocacy, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania 15213, USA. rberger@pitt.edu
Insights
Biomarker concentrations, including neuron-specific enolase (NSE), S100B, and myelin basic protein (MBP), can help predict outcomes in children with traumatic brain injury (TBI). Higher levels indicate worse outcomes, aiding in prognosis and rehabilitation planning.
Area of Science:
- Pediatric Traumatic Brain Injury
- Biomarker Discovery
- Neurology
Background:
- Predicting outcomes in pediatric traumatic brain injury (TBI) is crucial for family counseling and guiding rehabilitation.
- Current methods for outcome prediction may benefit from objective biological markers.
Purpose of the Study:
- To determine if serum concentrations of specific biomarkers at the time of injury correlate with outcomes in children with TBI.
- To investigate the predictive value of neuron-specific enolase (NSE), S100B, and myelin basic protein (MBP) for TBI outcomes.
Main Methods:
- Serial serum samples were collected from 152 children with acute TBI.
- Concentrations of NSE, S100B, and MBP were measured.
- Outcome was assessed using the Glasgow Outcome Scale (GOS) and GOS-Extended Pediatric (GOS-E Peds).
- Statistical analyses included Spearman's rank correlation and binary logistic regression.
Main Results:
- Higher concentrations of all measured biomarkers (NSE, S100B, MBP) were significantly associated with worse outcomes.
- NSE and MBP showed stronger correlations with outcome in younger children (≤4 years).
- A logistic regression model using biomarker concentrations achieved a 77% correct classification rate for predicting dichotomous GOS outcomes.
Conclusions:
- Serum concentrations of NSE, S100B, and MBP obtained early after TBI are potential predictors of outcome in children.
- These biomarkers may assist in prognostication and informing clinical management decisions.
- Further research is needed to compare biomarker utility against clinical variables and explore continuous outcome measures.
Abstract:
Predicting outcome after pediatric traumatic brain injury (TBI) is important for providing information to families and prescribing rehabilitation services. The study objective was to assess whether biomarkers concentrations obtained at the time of injury are associated with outcome. Serial serum concentrations of neuron-specific enolase (NSE), S100B and myelin basic protein (MBP) were measured in 152 children with acute TBI. Outcome was assessed with the Glasgow Outcome Scale (GOS) score and/or GOS-Extended Pediatric (GOS-E Peds). Spearman's rank correlation and binary logistic regression assessed the relationship between biomarker concentrations and outcome. For all biomarkers and time points, higher biomarker concentrations were associated with worse outcome. Initial and peak NSE concentrations and initial MBP concentrations were more strongly correlated with outcome in children < or =4 years compared with those >4 years of age. Using binary logistic regression to evaluate the simultaneous affect of all biomarkers on outcome, there was significant overall model fit predicting a dichotomous GOS from biomarker concentrations with a 77% correct classification rate and a negative and positive predictive value of 97% and 75%, respectively. We conclude that NSE, S100B, and MBP concentrations obtained at the time of TBI may be useful in predicting outcome. Future studies should focus on assessing the differential benefit of biomarkers compared with clinical variables and in assessing a continuous rather than categorical outcome variable.
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