Biomarkers for paediatric traumatic brain injury

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide with a substantial health and socioeconomic impact. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (874) Google Scholar , 2 Kochanek PM Tasker RC Carney N et al. Guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the Brain Trauma Foundation Guidelines, executive summary. Neurosurgery. 2019; 84: 1169-1178 Crossref PubMed Scopus (49) Google Scholar The potential long-term sequelae of mild TBI are becoming increasingly apparent. 2 Kochanek PM Tasker RC Carney N et al. Guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the Brain Trauma Foundation Guidelines, executive summary. Neurosurgery. 2019; 84: 1169-1178 Crossref PubMed Scopus (49) Google Scholar , 3 Lugones M Parkin G Bjelosevic S et al. Blood biomarkers in paediatric mild traumatic brain injury: a systematic review. Neurosci Biobehav Rev. 2018; 87: 206-217 Crossref PubMed Scopus (23) Google Scholar , 4 Strathmann FG Schulte S Goerl K Petron DJ Blood-based biomarkers for traumatic brain injury: evaluation of research approaches, available methods and potential utility from the clinician and clinical laboratory perspectives. Clin Biochem. 2014; 47: 876-888 Crossref PubMed Scopus (59) Google Scholar Tools to assess injury severity, monitor patients for early signs of clinical deterioration, and improve prognosis are being investigated. For these reasons, brain biomarkers have attracted increasing interest, with more than 90 different biomarkers studied in paediatric patients with TBI to date. 5 Prout AJ Wolf MS Fink EL Translating biomarkers from research to clinical use in pediatric neurocritical care: focus on traumatic brain injury and cardiac arrest. Curr Opin Pediatr. 2017; 29: 272-279 Crossref PubMed Scopus (10) Google Scholar , 6 Papa L Ramia MM Kelly JM Burks SS Pawlowicz A Berger RP Systematic review of clinical research on biomarkers for pediatric traumatic brain injury. J Neurotrauma. 2013; 30: 324-338 Crossref PubMed Scopus (87) Google Scholar The ideal biomarker would indicate the site of injury and its concentration would indicate severity. Despite major research efforts, 3 Lugones M Parkin G Bjelosevic S et al. Blood biomarkers in paediatric mild traumatic brain injury: a systematic review. Neurosci Biobehav Rev. 2018; 87: 206-217 Crossref PubMed Scopus (23) Google Scholar , 6 Papa L Ramia MM Kelly JM Burks SS Pawlowicz A Berger RP Systematic review of clinical research on biomarkers for pediatric traumatic brain injury. J Neurotrauma. 2013; 30: 324-338 Crossref PubMed Scopus (87) Google Scholar the clinical association between biomarker concentrations and disease severity, clinical and radiological findings, and patient outcome is weak. Additional challenges of studying paediatric patients with TBI are their age-related anatomical and physiological differences, both systemic and in the developing brain, that might contribute to different normative and consequently disease-related biomarker concentrations across the paediatric age range. 4 Strathmann FG Schulte S Goerl K Petron DJ Blood-based biomarkers for traumatic brain injury: evaluation of research approaches, available methods and potential utility from the clinician and clinical laboratory perspectives. Clin Biochem. 2014; 47: 876-888 Crossref PubMed Scopus (59) Google Scholar , 6 Papa L Ramia MM Kelly JM Burks SS Pawlowicz A Berger RP Systematic review of clinical research on biomarkers for pediatric traumatic brain injury. J Neurotrauma. 2013; 30: 324-338 Crossref PubMed Scopus (87) Google Scholar , 7 Figaji AA Anatomical and physiological differences between children and adults relevant to traumatic brain injury and the implications for clinical assessment and care. Front Neurol. 2017; 8: 685 Crossref PubMed Scopus (57) Google Scholar Characterisation of serum total tau following paediatric traumatic brain injury: a case-control studySerum total tau might help to differentiate between patients with mild TBI (GCS 13–14 vs GCS 15), but larger studies are needed to validate these results before this biomarker can be used for diagnosis and prognosis. Full-Text PDF