title: Fluid Biomarkers of Traumatic Brain Injury and Intended Context of Use.
abstract: Traumatic brain injury (TBI) is one of the leading causes of death and disability around the world. The lack of validated biomarkers for TBI is a major impediment to developing effective therapies and improving clinical practice, as well as stimulating much work in this area. In this review, we focus on different settings of TBI management where blood or cerebrospinal fluid (CSF) biomarkers could be utilized for predicting clinically-relevant consequences and guiding management decisions. Requirements that the biomarker must fulfill differ based on the intended context of use (CoU). Specifically, we focus on fluid biomarkers in order to: (1) identify patients who may require acute neuroimaging (cranial computerized tomography (CT) or magnetic resonance imaging (MRI); (2) select patients at risk for secondary brain injury processes; (3) aid in counseling patients about their symptoms at discharge; (4) identify patients at risk for developing postconcussive syndrome (PCS), posttraumatic epilepsy (PTE) or chronic traumatic encephalopathy (CTE); (5) predict outcomes with respect to poor or good recovery; (6) inform counseling as to return to work (RTW) or to play. Despite significant advances already made from biomarker-based studies of TBI, there is an immediate need for further large-scale studies focused on identifying and innovating sensitive and reliable TBI biomarkers. These studies should be designed with the intended CoU in mind.
authors.affiliation: Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Rockville, MD 20856, USA. tanya.bogoslovsky.ctr@usuhs.edu.
authors.forename: Tanya
authors.initials: T
authors.lastname: Bogoslovsky
authors.affiliation: National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20814, USA. jessica.gill@nih.gov.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gill
authors.affiliation: Quanterix Inc., Lexington, MA 02421, USA. ajeromin@quanterix.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Jeromin
authors.affiliation: Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Rockville, MD 20856, USA. cora.davis.ctr@usuhs.edu.
authors.forename: Cora
authors.initials: C
authors.lastname: Davis
authors.affiliation: Director, Traumatic Brain Injury Clinical Research Center, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA. ramondia@mail.med.upenn.edu.
authors.forename: Ramon
authors.initials: R
authors.lastname: Diaz-Arrastia
keywords: TBI management; biomarkers; traumatic brain injury (TBI)