title: Serum biomarker concentrations and outcome after pediatric traumatic brain injury.
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.
authors.affiliation: Department 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
authors.forename: Rachel Pardes
authors.initials: RP
authors.lastname: Berger
authors.forename: Sue R
authors.initials: SR
authors.lastname: Beers
authors.forename: Rudolph
authors.initials: R
authors.lastname: Richichi
authors.forename: Daniel
authors.initials: D
authors.lastname: Wiesman
authors.forename: P David
authors.initials: PD
authors.lastname: Adelson
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000097:blood*; D001930:Brain Injuries / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D004676:Myelin Basic Protein / Q000097:blood*; D009414:Nerve Growth Factors / Q000097:blood*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*
chemical_list: D015415:Biomarkers; D004676:Myelin Basic Protein; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D010751:Phosphopyruvate Hydratase