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Serum Biomarkers Help Predict Attention Problems in Critically Ill Children With Traumatic Brain Injury
Amy A Wilkinson1, Nevena Simic, Helena Frndova
11Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada. 2Department of Psychology, University of Toronto, Toronto, ON, Canada. 3The Comprehensive Pediatric Epilepsy Program, Hamilton Health Sciences Corporation, Hamilton, ON, Canada. 4Department of Critical Care, The Hospital for Sick Children, Toronto, ON, Canada. 5Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON Canada. 6Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Hamilton, Hamilton, ON, Canada. 7The Division of Pediatric Critical Care Medicine, Children's Hospital of the London Health Sciences Centre and the Lawson Research Institute, London, ON, Canada. 8Department of Pediatrics, Children's Hospital of the London Health Sciences Centre and the Lawson Research Institute, London, ON, Canada. 9Pediatrics, Western University, London, ON, Canada. 10Division of Neurology, Children's Hospital of the London Health Sciences Centre and the Lawson Research Institute, London, ON, Canada. 11Clinical Neurological Sciences and Epidemiology, Schulich School of Medicine, Western University, London, ON, Canada. 12Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 13Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 14Mental Health Outpatient Services, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 15Smyth Medical Centre, Ottawa, ON, Canada. 16Department of Psychology, Université de Montréal, Montréal, QC, Canada. 17Ste-Justine Hospital Research Center, Montreal, QC, Canada. 18Division of Pediatric Intensive Care, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada. 19Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia. 20Psychological Sciences and Pediatrics, University of Melbourne, Melbourne, VIC, Australia. 21Institute of Medical Sciences, University of Toronto, Toronto,
Insights
Early detection of attention deficits after childhood traumatic brain injury (TBI) is possible. Combining pre-injury attention levels with serum biomarkers like neuron-specific enolase can predict long-term inattention following TBI.
Area of Science:
- Pediatric neurology
- Neurotrauma research
- Biomarker discovery
Background:
- Traumatic brain injury (TBI) in children can lead to long-term cognitive deficits, particularly affecting attention.
- Identifying early predictors of attention deficits post-TBI is crucial for timely intervention and improved outcomes.
- Current assessment methods may not fully capture the risk for developing sustained inattention.
Purpose of the Study:
- To evaluate the association between acute serum biomarkers and changes in attention 1 year after pediatric traumatic brain injury.
- To identify reliable early predictors of long-term attention deficits following childhood TBI.
Main Methods:
- A prospective observational study involving 58 children (aged 5-17) with TBI across five Canadian pediatric intensive care units.
- Measurement of nine serum biomarkers multiple times during the first week post-injury.
- Assessment of attention using the Conners Third Parent Rating Scale at baseline (pre-injury) and 1 year post-injury.
Main Results:
- Children showed significantly more inattention symptoms at 1 year compared to baseline.
- A combination of high baseline inattention and elevated serum neuron-specific enolase levels was the strongest predictor of developing inattention at 1 year.
- Glasgow Coma Scale scores and age at injury were not associated with 1-year inattention outcomes.
Conclusions:
- Combining baseline attention assessments with acute serum biomarker measurements offers a promising approach for predicting long-term attention deficits after pediatric TBI.
- This strategy can aid in the early identification of children at risk for persistent inattention, facilitating targeted support and management.
Objective:
To evaluate the association between acute serum biomarkers, and the changes in attention at 1 year following traumatic brain injury.
Design And Setting:
A prospective observational and laboratory study conducted in PICUs at five Canadian children's hospitals.
Study Population And Measurements:
Fifty-eight patients aged 5 to 17 years with traumatic brain injury were enrolled in the study. Nine brain-specific and inflammatory serum protein biomarkers were measured multiple times over the first week following injury. Attention was measured at "baseline" to represent pre-injury function and at 1 year following injury using the Conners Third Parent Rating Scale.
Results:
Compared with baseline, there were significantly more clinical symptoms of inattention at 1 year post injury. The Glasgow Coma Scale score, age at injury, baseline levels of inattention, and highest levels of serum biomarkers were used to estimate the probability of developing inattention. These independent variables were first evaluated individually followed by combinations of the best predictors using area under the receiver operating characteristic curve analyses. A combination of high baseline levels of inattention and high serum levels of the biomarker neuron-specific enolase was the best predictor for inattention. Glasgow Coma Scale and age at injury were not associated with inattention at 1 year post injury.
Conclusions:
Combining baseline assessment of attention with measurement of serum biomarkers shows promise as reliable, early predictors of long-term attention after childhood traumatic brain injury.
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