title: Cerebrospinal fluid biomarkers versus glasgow coma scale and glasgow outcome scale in pediatric traumatic brain injury: the role of young age and inflicted injury.
abstract: The Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) are widely used clinical scoring systems to measure the severity of neurologic injury after traumatic brain injury (TBI), but have recognized limitations in infants and small children. Cerebrospinal fluid (CSF) concentrations of neuron-specific enolase (NSE) and S100B show promise as markers of brain injury. We hypothesized that the initial GCS and 6-month GOS scores would be inversely associated with CSF NSE and/or S100B concentrations after severe pediatric TBI. Using banked CSF obtained during ongoing studies of pediatric TBI, NSE and S100B were determined in CSF collected within 24 h of trauma from 88 infants and children with severe TBI (GCS < or = 8) versus 20 non-injured controls. Victims of inflicted (iTBI) and non-inflicted TBI (nTBI) showed similar (>10-fold) increases in both NSE and S100B versus control. Both markers showed overall significant, inverse correlation with GCS and GOS scores. In subgroup analysis, both markers correlated significantly with GCS and GOS scores only in older (>4 years) victims of nTBI; no correlation was found for patients < or =4 years old or victims of iTBI. While confirming the overall correlations between GCS/GOS score and CSF NSE and S100B seen in prior studies, we conclude that these clinical and CSF biomarkers of brain injury do not correlate in children < or =4 years of age and/or victims of iTBI. Although further, prospective study is warranted, these findings suggest important limitations in our current ability to assess injury severity in this important population.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Division of Critical Care Services, Children's Medical Center of Dallas, 1935 Motor Street, Dallas, TX 73235, USA. paul.shore@childrens.com
authors.forename: Paul M
authors.initials: PM
authors.lastname: Shore
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Berger
authors.forename: Sumeeta
authors.initials: S
authors.lastname: Varma
authors.forename: Keri L
authors.initials: KL
authors.lastname: Janesko
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Robert S B
authors.initials: RS
authors.lastname: Clark
authors.forename: P David
authors.initials: PD
authors.lastname: Adelson
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Thomas
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Lai
authors.forename: Hülya
authors.initials: H
authors.lastname: Bayir
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
mesh_terms: D000375:Aging / Q000502:physiology*; D015415:Biomarkers; D001930:Brain Injuries / Q000134:cerebrospinal fluid*; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid*; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D010751:Phosphopyruvate Hydratase / Q000134:cerebrospinal fluid; D012189:Retrospective Studies; D009418:S100 Proteins / Q000134:cerebrospinal fluid
chemical_list: D015415:Biomarkers; D002556:Cerebrospinal Fluid Proteins; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase