Evaluating Diagnostic Strategies for Pediatric Traumatic Brain Injury: A Literature-Based Clinical Decision Analysis

To evaluate the role of blood-based biomarkers in pediatric traumatic brain injury (TBI) using a clinical decision analysis (CDA) framework, with the goal of determining whether biomarker integration improves diagnostic accuracy, reduces unnecessary imaging, and supports clinical decision-making.

We developed a CDA model to compare standard clinical assessment strategies/decision rules for children with suspected mild TBI vs strategies incorporating biomarker measurement. Model inputs included published estimates of biomarker test performance (sensitivity, specificity), rates of clinically important TBI, and imaging utilization. Outcomes included diagnostic yield, false-positive and false-negative rates, and projected reductions in neuroimaging. Sensitivity analyses explored the robustness of findings across a range of disease prevalences.

Biomarker-enhanced strategies consistently reduced unnecessary head computed tomography utilization compared with clinical assessment alone. Decision-analytic modeling indicated that its integration into assessment strategies could meaningfully decrease radiation exposure at a population level. Sensitivity analyses demonstrated that findings were robust across plausible ranges of injury prevalence.

Application of CDA to pediatric TBI demonstrates the potential value of biomarker integration in improving diagnostic accuracy and optimizing computed tomography utilization. Biomarker-augmented strategies may enhance patient safety by reducing unnecessary radiation exposure, while maintaining sensitivity for clinically important injuries. Prospective validation and real-world implementation studies are needed to confirm clinical effectiveness and cost-effectiveness.