title: Biomarkers for the clinical differential diagnosis in traumatic brain injury--a systematic review.
abstract: Rapid triage and decision-making in the treatment of traumatic brain injury (TBI) present challenging dilemma in "resource poor" environments such as the battlefield and developing areas of the world. There is an urgent need for additional tools to guide treatment of TBI. The aim of this review is to establish the possible use of diagnostic TBI biomarkers in (1) identifying diffuse and focal brain injury and (2) assess their potential for determining outcome, intracranial pressure (ICP), and responses to therapy. At present, there is insufficient literature to support a role for diagnostic biomarkers in distinguishing focal and diffuse injury or for accurate determination of raised ICP. Presently, neurofilament (NF), S100β, glial fibrillary acidic protein (GFAP), and ubiquitin carboxyl terminal hydrolase-L1 (UCH-L1) seemed to have the best potential as diagnostic biomarkers for distinguishing focal and diffuse injury, whereas C-tau, neuron-specific enolase (NSE), S100β, GFAP, and spectrin breakdown products (SBDPs) appear to be candidates for ICP reflective biomarkers. With the combinations of different pathophysiology related to each biomarker, a multibiomarker analysis seems to be effective and would likely increase diagnostic accuracy. There is limited research focusing on the differential diagnostic properties of biomarkers in TBI. This fact warrants the need for greater efforts to innovate sensitive and reliable biomarkers. We advocate awareness and inclusion of the differentiation of injury type and ICP elevation in further studies with brain injury biomarkers.
authors.affiliation: Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA. SYokobori@med.miami.edu
authors.forename: Shoji
authors.initials: S
authors.lastname: Yokobori
authors.forename: Khadil
authors.initials: K
authors.lastname: Hosein
authors.forename: Stephen
authors.initials: S
authors.lastname: Burks
authors.forename: Ishna
authors.initials: I
authors.lastname: Sharma
authors.forename: Shyam
authors.initials: S
authors.lastname: Gajavelli
authors.forename: Ross
authors.initials: R
authors.lastname: Bullock
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D001930:Brain Injuries / Q000175:diagnosis* / Q000201:enzymology / Q000378:metabolism*; D003937:Diagnosis, Differential; D005904:Glial Fibrillary Acidic Protein / Q000378:metabolism; D006801:Humans; D010751:Phosphopyruvate Hydratase / Q000378:metabolism; D064568:S100 Calcium Binding Protein beta Subunit / Q000378:metabolism; D013049:Spectrin / Q000378:metabolism; D043222:Ubiquitin Thiolesterase / Q000378:metabolism; D016875:tau Proteins / Q000378:metabolism
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human; C482860:UCHL1 protein, human; D016875:tau Proteins; D013049:Spectrin; D043222:Ubiquitin Thiolesterase; D010751:Phosphopyruvate Hydratase
keywords: Biomarkers; Differential diagnosis; Intracranial hypertension; Pathophysiology; Traumatic brain injury