title: Clinical applications of biomarkers in pediatric traumatic brain injury.
abstract: BACKGROUND
  The diagnosis, treatment, and prediction of outcome in pediatric traumatic brain injury (TBI) present significant challenges to the treating clinician. Clinical and radiological tools for assessing injury severity and predicting outcome, in particular, lack sensitivity and specificity. In patients with mild TBI, often there is uncertainty about which patients should undergo radiological imaging and who is at risk for long term neurological sequelae. In severe TBI, often there is uncertainty about which patients will experience secondary insults and what the outcome for individual patients will be. In several other clinical specialties, biomarkers are used to diagnose disease, direct treatment, and prognosticate. However, an ideal biomarker for brain injury has not been found.
  
  
  METHODS
  In this review, we examine the various factors that must be taken into account in the search for a reliable biomarker in brain injury. We review the important studies that have investigated common biomarkers of structural brain injury, in particular S100B, neuron-specific enolase, myelin basic protein, and glial fibrillary acid protein.
  
  
  CONCLUSIONS
  The potential uses and limitations of these biomarkers in the context of TBI are discussed.
authors.affiliation: Division of Neurosurgery, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa.
authors.forename: Simon J I
authors.initials: SJ
authors.lastname: Sandler
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Figaji
authors.forename: P David
authors.initials: PD
authors.lastname: Adelson
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000378:metabolism*; D001930:Brain Injuries / Q000175:diagnosis / Q000378:metabolism*; D002648:Child; D006801:Humans
chemical_list: D015415:Biomarkers