title: Are UCH-L1 and GFAP promising biomarkers for children with mild traumatic brain injury?
abstract: To compare serum biomarker levels between children with mild traumatic brain injury (mTBI) and orthopaedic injury (OI), acutely following injury. Secondarily, to explore the association between biomarker levels and symptom burden over 1 month post-injury.
  
  
  
  This was a prospective cohort study of children aged 11-16 years who presented to the emergency department within 6 hours of sustaining mTBI or isolated extremity OI. Serum was drawn at the time of study enrollment and levels of ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) and glial fibrillary acid protein (GFAP) were analysed. Symptom burden was assessed by the Post-Concussion Symptom Scale (PCSS) acutely following injury and at three subsequent time points over 1 month.
  
  
  
  Twenty-five children with mTBI and 20 children with OI were enrolled. The average age for the overall cohort was 13 (± 1.6) years and the majority were male and injured playing sports. GFAP levels and PCSS scores were significantly higher acutely following mTBI vs OI (p < 0.01). There was not a significant group difference in UCH-L1 levels. Neither GFAP nor UCH-L1 were predictive of PCSS scores over the 1month post-injury.
  
  
  
  GFAP may be a promising diagnostic tool for children with mTBI. Additional approaches are needed to predict symptom severity and persistence.
authors.affiliation: a Division of Pediatric Emergency Medicine.
authors.forename: Tara
authors.initials: T
authors.lastname: Rhine
authors.affiliation: a Division of Pediatric Emergency Medicine.
authors.forename: Lynn
authors.initials: L
authors.lastname: Babcock
authors.affiliation: b Division of Biostatistics.
authors.forename: Nanhua
authors.initials: N
authors.lastname: Zhang
authors.affiliation: c Division of Medical Imaging.
authors.forename: James
authors.initials: J
authors.lastname: Leach
authors.affiliation: d Division of Physical Medicine and Rehabilitation Department of Pediatrics , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Wade
mesh_terms: D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000097:blood* / Q000000981:diagnostic imaging; D002648:Child; D015331:Cohort Studies; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018709:Statistics, Nonparametric; D015599:Trauma Severity Indices; D043222:Ubiquitin Thiolesterase / Q000097:blood*
chemical_list: D005904:Glial Fibrillary Acidic Protein; C482860:UCHL1 protein, human; D043222:Ubiquitin Thiolesterase
keywords: Paediatric; biomarkers; concussion; diagnosis