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Morello A, Schiavetti I, Lo Bue E, Portonero I, Colonna S, Gatto A, Pavanello M, Lanotte MM, Garbossa D, Cofano F. Update on the role of S100B in traumatic brain injury in pediatric population: a meta-analysis. Childs Nerv Syst 2024:10.1007/s00381-024-06565-8. [PMID: 39177800 DOI: 10.1007/s00381-024-06565-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE Cranial computed tomography (CT) scan is the most widely used tool to rule out intracranial lesions after pediatric traumatic brain injury (TBI). However, in pediatric population, the radiation exposure can lead to an increased risk of hematological and brain neoplasm. Defined in 2019 National Institute for Health and Care Excellence (NICE) guidelines as "troponins for the brain", serum biomarkers measurements, particularly S100B, have progressively emerged as a supplementary tool in the management of TBI thanks to their capacity to predict intracranial post-traumatic lesions. METHODS This systematic review was conducted following the PRISMA protocol (preferred reporting items for systematic reviews and meta-analyses). No chronological limits of study publications were included. Studies reporting data from children with TBI undergoing serum S100B measurement and computed tomography (CT) scans were included. RESULTS Of 380 articles screened, 10 studies met the inclusion criteria. Patients admitted with mild-TBI in the Emergency Department (ED) were 1325 (80.25%). The overall pooled sensitivity and specificity were 98% (95% CI, 92-99%) and 45% (95% CI, 29-63%), respectively. The meta-analysis revealed a high negative predictive value (NVP) (99%; 95% CI, 94-100%) and a low positive predictive value (PPV) (41%; 95% CI, 16-79%). Area under the curve (AUC) was 76% (95% CI, 65-85%). The overall pooled negative predictive value (NPV) was 99% (95% CI, 99-100%). CONCLUSIONS The measurement of serum S100B in the diagnostic workflow of mTBI could help informed decision-making in the ED setting, potentially safely reducing the use of CT scan in the pediatric population. The high sensitivity and excellent negative predictive values look promising and seem to be close to the values found in adults. Despite this, it must be pointed out the high heterogeneity (> 90%) found among studies. In order for S100B to be regularly introduced in the pediatric workflow for TBI, it is important to conduct further studies to obtain cut-off levels based on pediatric reference intervals.
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Affiliation(s)
- Alberto Morello
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy.
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Enrico Lo Bue
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Irene Portonero
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Stefano Colonna
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Andrea Gatto
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michele Maria Lanotte
- Stereotactic and Functional Neurosurgery Unit, Department of Neuroscience, Rita Levi Montalcini", AOU Città Della Salute E Della Scienza Di Torino, University Hospital, University of Turin, Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
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Nwafor DC, Brichacek AL, Foster CH, Lucke-Wold BP, Ali A, Colantonio MA, Brown CM, Qaiser R. Pediatric Traumatic Brain Injury: An Update on Preclinical Models, Clinical Biomarkers, and the Implications of Cerebrovascular Dysfunction. J Cent Nerv Syst Dis 2022; 14:11795735221098125. [PMID: 35620529 PMCID: PMC9127876 DOI: 10.1177/11795735221098125] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/14/2022] [Indexed: 11/15/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. Recent studies suggest that children and adolescents have worse post-TBI outcomes and take longer to recover than adults. However, the pathophysiology and progression of TBI in the pediatric population are studied to a far lesser extent compared to the adult population. Common causes of TBI in children are falls, sports/recreation-related injuries, non-accidental trauma, and motor vehicle-related injuries. A fundamental understanding of TBI pathophysiology is crucial in preventing long-term brain injury sequelae. Animal models of TBI have played an essential role in addressing the knowledge gaps relating to pTBI pathophysiology. Moreover, a better understanding of clinical biomarkers is crucial to diagnose pTBI and accurately predict long-term outcomes. This review examines the current preclinical models of pTBI, the implications of pTBI on the brain’s vasculature, and clinical pTBI biomarkers. Finally, we conclude the review by speculating on the emerging role of the gut-brain axis in pTBI pathophysiology.
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Affiliation(s)
- Divine C. Nwafor
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
- West Virginia University School of Medicine, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Allison L. Brichacek
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Chase H. Foster
- Department of Neurosurgery, George Washington University Hospital, Washington D.C., USA
| | | | - Ahsan Ali
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Candice M. Brown
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Rabia Qaiser
- Department of Neurosurgery, Baylor Scott and White, Temple, TX, USA
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Biomarkers in Moderate to Severe Pediatric Traumatic Brain Injury: A Review of the Literature. Pediatr Neurol 2022; 130:60-68. [PMID: 35364462 PMCID: PMC9038667 DOI: 10.1016/j.pediatrneurol.2022.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite decades of research, outcomes in pediatric traumatic brain injury (pTBI) remain highly variable. Brain biofluid-specific biomarkers from pTBI patients may allow us to diagnose and prognosticate earlier and with a greater degree of accuracy than conventional methods. This manuscript reviews the evidence surrounding current brain-specific biomarkers in pTBI and assesses the temporal relationship between the natural history of the traumatic brain injury (TBI) and measured biomarker levels. METHODS A literature search was conducted in the Ovid, PubMed, MEDLINE, and Cochrane databases seeking relevant publications. The study selection and screening process were documented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Extraction forms included developmental stages of patients, type and biofluid source of biomarkers, brain injury type, and other relevant data. RESULTS The search strategy identified 443 articles, of which 150 examining the biomarkers of our interest were included. The references retrieved were examined thoroughly and discussed at length with a pediatric neurocritical care intensivist specializing in pTBI and a Ph.D. scientist with a high degree of involvement in TBI biomarker research, authoring a vast amount of literature in this field. CONCLUSIONS TBI biomarkers might serve as valuable tools in the diagnosis and prognosis of pTBI. However, while each biomarker has its advantages, they are not without limitations, and therefore, further research is critical in pTBI biomarkers.
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4
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Janigro D, Mondello S, Posti JP, Unden J. GFAP and S100B: What You Always Wanted to Know and Never Dared to Ask. Front Neurol 2022; 13:835597. [PMID: 35386417 PMCID: PMC8977512 DOI: 10.3389/fneur.2022.835597] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/03/2022] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) is a major global health issue, with outcomes spanning from intracranial bleeding, debilitating sequelae, and invalidity with consequences for individuals, families, and healthcare systems. Early diagnosis of TBI by testing peripheral fluids such as blood or saliva has been the focus of many research efforts, leading to FDA approval for a bench-top assay for blood GFAP and UCH-L1 and a plasma point-of-care test for GFAP. The biomarker S100B has been included in clinical guidelines for mTBI (mTBI) in Europe. Despite these successes, several unresolved issues have been recognized, including the robustness of prior data, the presence of biomarkers in tissues beyond the central nervous system, and the time course of biomarkers in peripheral body fluids. In this review article, we present some of these issues and provide a viewpoint derived from an analysis of existing literature. We focus on two astrocytic proteins, S100B and GFAP, the most commonly employed biomarkers used in mTBI. We also offer recommendations that may translate into a broader acceptance of these clinical tools.
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Affiliation(s)
- Damir Janigro
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, United States.,FloTBI, Cleveland, OH, United States
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Jussi P Posti
- Department of Neurosurgery, Neurocenter, Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Johan Unden
- Department of Operation and Intensive Care, Hallands Hospital Halmstad, Lund University, Lund, Sweden
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5
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Ganeshalingham A, Beca J. Serum biomarkers in severe paediatric traumatic brain injury-a narrative review. Transl Pediatr 2021; 10:2720-2737. [PMID: 34765496 PMCID: PMC8578762 DOI: 10.21037/tp-20-386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/14/2021] [Indexed: 11/22/2022] Open
Abstract
Severe traumatic brain injury continues to present complex management and prediction challenges for the clinician. While there is some evidence that better systems of care can improve outcome, multiple multi-centre randomised controlled trials of specific therapies have consistently failed to show benefit. In addition, clinicians are challenged in attempting to accurately predict which children will recover well and which children will have severe and persisting neurocognitive deficits. Traumatic brain injury is vastly heterogeneous and so it is not surprising that one therapy or approach, when applied to a mixed cohort of children in a clinical trial setting, has yielded disappointing results. Children with severe traumatic brain injury have vastly different brain injury pathologies of widely varying severity, in any number of anatomical locations at what may be disparate stages of brain development. This heterogeneity may also explain why clinicians are unable to accurately predict outcome. Biomarkers are objective molecular signatures of injury that are released following traumatic brain injury and may represent a way of unifying the heterogeneity of traumatic brain injury into a single biosignature. Biomarkers hold promise to diagnose brain injury severity, guide intervention selection for clinical trials, or provide vital prognostic information so that early intervention and rehabilitation can be planned much earlier in the course of a child's recovery. Serum S100B and serum NSE levels show promise as a diagnostic tool with biomarker levels significantly higher in children with severe TBI including children with inflicted and non-inflicted head injury. Serum S100B and serum NSE also show promise as a predictor of neurodevelopmental outcome. The role of biomarkers in traumatic brain injury is an evolving field with the potential for clinical application within the next few years.
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Affiliation(s)
| | - John Beca
- Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
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6
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Weber B, Lackner I, Braun CK, Kalbitz M, Huber-Lang M, Pressmar J. Laboratory Markers in the Management of Pediatric Polytrauma: Current Role and Areas of Future Research. Front Pediatr 2021; 9:622753. [PMID: 33816396 PMCID: PMC8010656 DOI: 10.3389/fped.2021.622753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Severe trauma is the most common cause of mortality in children and is associated with a high socioeconomic burden. The most frequently injured organs in children are the head and thorax, followed by the extremities and by abdominal injuries. The efficient and early assessment and management of these injuries is essential to improve patients' outcome. Physical examination as well as imaging techniques like ultrasound, X-ray and computer tomography are crucial for a valid early diagnosis. Furthermore, laboratory analyses constitute additional helpful tools for the detection and monitoring of pediatric injuries. Specific inflammatory markers correlate with post-traumatic complications, including the development of multiple organ failure. Other laboratory parameters, including lactate concentration, coagulation parameters and markers of organ injury, represent further clinical tools to identify trauma-induced disorders. In this review, we outline and evaluate specific biomarkers for inflammation, acid-base balance, blood coagulation and organ damage following pediatric polytrauma. The early use of relevant laboratory markers may assist decision making on imaging tools, thus contributing to minimize radiation-induced long-term consequences, while improving the outcome of children with multiple trauma.
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Affiliation(s)
- Birte Weber
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Ina Lackner
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Christian Karl Braun
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany.,Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Miriam Kalbitz
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany
| | - Jochen Pressmar
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
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Mannix R, Levy R, Zemek R, Yeates KO, Arbogast K, Meehan WP, Leddy J, Master C, Mayer AR, Howell DR, Meier TB. Fluid Biomarkers of Pediatric Mild Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2020; 37:2029-2044. [DOI: 10.1089/neu.2019.6956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel Levy
- Medical College of Georgia, Augusta, Georgia, USA
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kristy Arbogast
- Division of Emergency Medicine, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William P. Meehan
- Micheli Center for Sports Injury Prevention, Division of Sports Medicine and Department of Pediatrics Boston Children's Hospital, Boston, Massachusetts, USA
| | - John Leddy
- UBMD Department of Orthopedics and Sports Medicine, State University of New York at Buffalo, Buffalo, New York, USA
| | - Christina Master
- Sports Medicine and Performance Center, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew R. Mayer
- Mind Research Network/LBERI and Departments of Psychology, Neurology, and Psychiatry, University of New Mexico, Albuquerque, New Mexico, USA
| | - David R. Howell
- Children's Hospital Colorado Sports Medicine Center and Department of Orthopedics University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Timothy B. Meier
- Departments of Neurosurgery, Cell Biology, Neurobiology and Anatomy, and Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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8
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Sönnerqvist C, Brus O, Olivecrona M. Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children. Eur J Trauma Emerg Surg 2020; 47:1163-1173. [PMID: 31907552 PMCID: PMC8321988 DOI: 10.1007/s00068-019-01288-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
Background Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines. Methods We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study” by Kuppermann et al. (Lancet 374(9696):1160–1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted. Results We analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group. Conclusion Children with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.
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Affiliation(s)
| | - Ole Brus
- Clinical Epidemiology and Biostatics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Magnus Olivecrona
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Department of Anaesthesiology and Intensive Care, Section for Neurosurgery, Örebro University Hospital, Örebro, Sweden.
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9
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Hajiaghamemar M, Seidi M, Oeur RA, Margulies SS. Toward development of clinically translatable diagnostic and prognostic metrics of traumatic brain injury using animal models: A review and a look forward. Exp Neurol 2019; 318:101-123. [PMID: 31055005 PMCID: PMC6612432 DOI: 10.1016/j.expneurol.2019.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/11/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury is a leading cause of cognitive and behavioral deficits in children in the US each year. There is an increasing interest in both clinical and pre-clinical studies to discover biomarkers to accurately diagnose traumatic brain injury (TBI), predict its outcomes, and monitor its progression especially in the developing brain. In humans, the heterogeneity of TBI in terms of clinical presentation, injury causation, and mechanism has contributed to the many challenges associated with finding unifying diagnosis, treatment, and management practices. In addition, findings from adult human research may have little application to pediatric TBI, as age and maturation levels affect the injury biomechanics and neurophysiological consequences of injury. Animal models of TBI are vital to address the variability and heterogeneity of TBI seen in human by isolating the causation and mechanism of injury in reproducible manner. However, a gap between the pre-clinical findings and clinical applications remains in TBI research today. To take a step toward bridging this gap, we reviewed several potential TBI tools such as biofluid biomarkers, electroencephalography (EEG), actigraphy, eye responses, and balance that have been explored in both clinical and pre-clinical studies and have shown potential diagnostic, prognostic, or monitoring utility for TBI. Each of these tools measures specific deficits following TBI, is easily accessible, non/minimally invasive, and is potentially highly translatable between animals and human outcomes because they involve effort-independent and non-verbal tasks. Especially conspicuous is the fact that these biomarkers and techniques can be tailored for infants and toddlers. However, translation of preclinical outcomes to clinical applications of these tools necessitates addressing several challenges. Among the challenges are the heterogeneity of clinical TBI, age dependency of some of the biomarkers, different brain structure, life span, and possible variation between temporal profiles of biomarkers in human and animals. Conducting parallel clinical and pre-clinical research, in addition to the integration of findings across species from several pre-clinical models to generate a spectrum of TBI mechanisms and severities is a path toward overcoming some of these challenges. This effort is possible through large scale collaborative research and data sharing across multiple centers. In addition, TBI causes dynamic deficits in multiple domains, and thus, a panel of biomarkers combining these measures to consider different deficits is more promising than a single biomarker for TBI. In this review, each of these tools are presented along with the clinical and pre-clinical findings, advantages, challenges and prospects of translating the pre-clinical knowledge into the human clinical setting.
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Affiliation(s)
- Marzieh Hajiaghamemar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
| | - Morteza Seidi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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Oris C, Pereira B, Durif J, Simon-Pimmel J, Castellani C, Manzano S, Sapin V, Bouvier D. The Biomarker S100B and Mild Traumatic Brain Injury: A Meta-analysis. Pediatrics 2018; 141:peds.2018-0037. [PMID: 29716980 DOI: 10.1542/peds.2018-0037] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The usefulness of S100B has been noted as a biomarker in the management of mild traumatic brain injury (mTBI) in adults. However, S100B efficacy as a biomarker in children has previously been relatively unclear. OBJECTIVE A meta-analysis is conducted to assess the prognostic value of S100B in predicting intracerebral lesions in children after mTBI. DATA SOURCES Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and Google Scholar. STUDY SELECTION Studies including children suffering mTBI who underwent S100B measurement and computed tomography (CT) scans were included. DATA EXTRACTION Of 1030 articles screened, 8 studies met the inclusion criteria. RESULTS The overall pooled sensitivity and specificity were 100% (95% confidence interval [CI]: 98%-100%) and 34% (95% CI: 30%-38%), respectively. A second analysis was based on the collection of 373 individual data points from 4 studies. Sensitivity and specificity results, obtained from reference ranges in children with a sampling time <3 hours posttrauma, were 97% (95% CI: 84.2%-99.9%) and 37.5% (95% CI: 28.8%-46.8%), respectively. Only 1 child had a low S100B level and a positive CT scan result without clinically important traumatic brain injury. LIMITATIONS Only patients undergoing both a CT scan and S100B testing were selected for evaluation. CONCLUSIONS S100B serum analysis as a part of the clinical routine could significantly reduce the number of CT scans performed on children with mTBI. Sampling should take place within 3 hours of trauma. Cutoff levels should be based on pediatric reference ranges.
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Affiliation(s)
| | - Bruno Pereira
- Biostatistics Unit, Direction de la Recherche Clinique, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Julie Durif
- Department of Biochemistry and Molecular Biology, and
| | - Jeanne Simon-Pimmel
- Department of Pediatric Emergency Medicine, University Hospital, Nantes, France
| | - Christoph Castellani
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, University Hospital, Geneva, Switzerland; and
| | - Vincent Sapin
- Department of Biochemistry and Molecular Biology, and.,GReD, Université Clermont Auvergne, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Clermont-Ferrand, France
| | - Damien Bouvier
- Department of Biochemistry and Molecular Biology, and .,GReD, Université Clermont Auvergne, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Clermont-Ferrand, France
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Grandpierre RG, Bobbia X, de La Coussaye JE, Claret PG. Intérêt clinique des concentrations sériques de la protéine S100β dans l’évaluation des patients traumatisés crâniens. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les recommandations de la Société française de médecine d’urgence concernant la prise en charge des patients traumatisés crâniens légers ont été éditées en 2012, complétées par des recommandations sur la bonne utilisation du biomarqueur S100β deux ans plus tard. Grâce à son excellente valeur prédictive négative, la protéine S100β utilisée à travers des règles strictes de prescription a été définie comme une alternative solide à la tomodensitométrie. Cependant, plusieurs questions restent en suspens concernant le délai maximum de réalisation du prélèvement par rapport à l’heure du traumatisme, l’impact médicoéconomique, les variations en rapport avec l’âge du patient, l’impact des agents anticoagulants ou antiagrégants plaquettaires et l’utilité du dosage sérique de cette protéine dans d’autres cadres nosologiques.
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12
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Serum S100B Levels Can Predict Computed Tomography Findings in Paediatric Patients with Mild Head Injury. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6954045. [PMID: 29850551 PMCID: PMC5937551 DOI: 10.1155/2018/6954045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
Introduction Traumatic brain injuries (TBIs) are very common in paediatric populations, in which they are also a leading cause of death. Computed tomography (CT) overuse in these populations results in ionization radiation exposure, which can lead to lethal malignancies. The aims of this study were to investigate the accuracy of serum S100B levels with respect to the detection of cranial injury in children with mild TBI and to determine whether decisions regarding the performance of CT can be made based on biomarker levels alone. Materials and Methods This was a single-center prospective cohort study that was carried out from December 2016 to December 2017. A total of 80 children with mild TBI who met the inclusion criteria were included in the study. The patients were between 2 and 16 years of age. We determined S100B protein levels and performed head CTs in all the patients. Results Patients with cranial injury, as detected by CT, had higher S100B protein levels than those without cranial injury (p < 0.0001). We found that patients with cranial injury (head CT+) had higher mean S100B protein levels (0.527 μg L−1, 95% confidence interval (CI) 0.447–0.607 μg L−1) than did patients without cranial injury (head CT−) (0.145 μg L−1, 95% CI 0.138–0.152 μg L−1). Receiver operating characteristic (ROC) curve analysis clearly showed that S100B protein levels differed between patients with and without cranial injury at 3 hours after TBI (AUC = 0.893, 95% CI 0.786–0.987, p = 0.0001). Conclusion Serum S100B levels cannot replace clinical examinations or CT as tools for identifying paediatric patients with mild head injury; however, serum S100B levels can be used to identify low-risk patients to prevent such patients from being exposed to radiation unnecessarily.
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Blood biomarkers in paediatric mild traumatic brain injury: a systematic review. Neurosci Biobehav Rev 2018; 87:206-217. [DOI: 10.1016/j.neubiorev.2018.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/09/2018] [Accepted: 02/09/2018] [Indexed: 12/15/2022]
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Peacock WF, Van Meter TE, Mirshahi N, Ferber K, Gerwien R, Rao V, Sair HI, Diaz-Arrastia R, Korley FK. Derivation of a Three Biomarker Panel to Improve Diagnosis in Patients with Mild Traumatic Brain Injury. Front Neurol 2017; 8:641. [PMID: 29250027 PMCID: PMC5714862 DOI: 10.3389/fneur.2017.00641] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/15/2017] [Indexed: 12/21/2022] Open
Abstract
Background Nearly 5 million emergency department (ED) visits for head injury occur each year in the United States, of which <10% of patients show abnormal computed tomography (CT) findings. CT negative patients frequently suffer protracted somatic, behavioral, and neurocognitive dysfunction. Our goal was to evaluate biomarkers to identify mild TBI (mTBI) in patients with suspected head injury. Methods An observational ED study of head-injured and control patients was conducted at Johns Hopkins University (HeadSMART). Head CT was obtained (ACEP criteria) in patients with Glasgow Coma Scale scores of 13–15 and aged 18–80. Three candidate biomarker proteins, neurogranin (NRGN), neuron-specific enolase (NSE), and metallothionein 3 (MT3), were evaluated by immunoassay (samples <24 h from injury). American Congress of Rehabilitation Medicine (ACRM) criteria were used for diagnosis of mTBI patients for model building. Univariate analysis, logistic regression, and random forest (RF) algorithms were used for data analysis in R. Overall, 662 patients were studied. Statistical models were built using 328 healthy controls and 179 mTBI patients. Results Median time from injury was 5.9 h (IQR, 4.0; range 0.8–24 h). mTBI patients had elevated NSE, but decreased MT3 versus controls (p < 0.01 for each). NRGN was also elevated but within 2–6 h after injury. In the derivation set, the best model to distinguish mTBI from healthy controls used three markers, age, and sex as covariates (C-statistic = 0.91, sensitivity 98%, specificity 72%). Panel test accuracy was validated with the 155 remaining ACRM+ mTBI patients. Applying the RF model to the ACRM+ mTBI validation set resulted in 78% correctly classified as mTBI (119/153). CT positive and CT negative validation subsets were 91% and 75% correctly classified. In samples taken <2 h from injury, 100% (10/10) samples classified correctly, indicating that hyperacute testing is possible with these biomarker assays. The model accuracy varied from 72–100% overall, and had greater accuracy with increasing severity, as shown by comparing CT+ with CT− (91% versus 75%), and Injury Severity Score ≥16 versus <16 (88% versus 72%, respectively). Objective blood tests, detecting NRGN, NSE, and MT3, can be used to identify mTBI, irrespective of neuroimaging findings.
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Affiliation(s)
- W Frank Peacock
- Department of Emergency Medicine, Ben Taub Hospital, Houston, TX, United States
| | - Timothy E Van Meter
- Program for Neurological Diseases, ImmunArray, Inc., Richmond, VA, United States
| | - Nazanin Mirshahi
- Program for Neurological Diseases, ImmunArray, Inc., Richmond, VA, United States
| | - Kyle Ferber
- Program for Neurological Diseases, ImmunArray, Inc., Richmond, VA, United States
| | - Robert Gerwien
- Gerwien Statistical Consulting, Newington, CT, United States
| | - Vani Rao
- Department of Psychiatry and Behavioral Science, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - Haris Iqbal Sair
- Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, PA, United States
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
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Evaluation of the Roche® Elecsys and the Diasorin® Liaison S100 kits in the management of mild head injury in the emergency room. Clin Biochem 2017; 52:123-130. [PMID: 29122642 DOI: 10.1016/j.clinbiochem.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/29/2017] [Accepted: 11/05/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this single-center prospective study is to compare two commercially available S100ß kits (the Roche® Elecsys and the Diasorin® Liaison S100 kits) in terms of analytical and clinical performances in a population admitted in the emergency room for mild traumatic brain injury (mTBI). MATERIAL AND METHOD 110 patients were enrolled from September 2014 to May 2015. Blood sample draws were performed within 3h after head trauma and the study population was split into pediatric and adult subpopulations (>18years of age). RESULTS Although both kits correlated well, we observed a significant difference in terms of S100ß levels (P value<0.05) in both subpopulations. In the pediatric subpopulation, both kits showed elevated S100ß levels for the only patient (3.5%) who displayed abnormal findings on a CT-scan. However, we observed a poor agreement between both kits (Cohen's kappa=0.345, P value=0.077). In the adult subpopulation, a total of 10 patients (12.2%) had abnormal head computed tomography scans. Using the Roche® (cut off=0.1μg/L) and the Diasorin® (cut off=0.15μg/L) S100ß kits, brain injuries were detected with a sensitivity of 100% (95% CI: 65-100%) and 100% (95% CI: 63-100%) and a specificity of 15.28% (95% CI: 7.9-25.7%) and 24.64% (95% CI: 15-36.5) respectively. Finally, a moderate agreement was concluded between both kits (Cohen's kappa=0.569, P value=0.001). CONCLUSION Although a good correlation could be found between both kits, emergency physicians should be aware of discrepancies observed between both methods, making those immunoassays not interchangeable. Furthermore, more studies are still needed to validate cut off used according to technique and to age, especially in the population below the age of 2years.
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Abstract
Biomarkers are key tools and can provide crucial information on the complex cascade of events and molecular mechanisms underlying traumatic brain injury (TBI) pathophysiology. Obtaining a profile of distinct classes of biomarkers reflecting core pathologic mechanisms could enable us to identify and characterize the initial injury and the secondary pathologic cascades. Thus, they represent a logical adjunct to improve diagnosis, track progression and activity, guide molecularly targeted therapy, and monitor therapeutic response in TBI. Accordingly, great effort has been put into the identification of novel biomarkers in the past 25 years. However, the role of brain injury markers in clinical practice has been long debated, due to inconsistent regulatory standards and lack of reliable evidence of analytical validity and clinical utility. We present a comprehensive overview of the markers currently available while characterizing their potential role and applications in diagnosis, monitoring, drug discovery, and clinical trials in TBI. In reviewing these concepts, we discuss the recent inclusion of brain damage biomarkers in the diagnostic guidelines and provide perspectives on the validation of such markers for their use in the clinic.
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Manzano S, Holzinger IB, Kellenberger CJ, Lacroix L, Klima-Lange D, Hersberger M, La Scala G, Altermatt S, Staubli G. Diagnostic performance of S100B protein serum measurement in detecting intracranial injury in children with mild head trauma. Emerg Med J 2015; 33:42-6. [PMID: 26283067 DOI: 10.1136/emermed-2014-204513] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/28/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the accuracy of S100B serum level to detect intracranial injury in children with mild traumatic brain injury. METHODS A multicenter prospective cohort study was carried out in the paediatric emergency departments of three tertiary hospitals in Switzerland between January 2009 and December 2011. Participants included children aged <16 years with a mild traumatic brain injury (GCS ≥13) for whom a head CT was requested by the attending physician. Venous blood was obtained within 6 h of the trauma in all children for S100B measurement before a head CT was performed. As the S100B value was not available during the acute care period, the patient's management was not altered. The main measures were protein S100B value and the CT result. RESULTS 20/73 (27.4%) included children had an intracranial injury detected on CT. S100B receiver operating characteristics area under the curve was 0.73 (95% CI 0.60 to 0.86). With a 0.14 µg/L cut-off point, S100B reached an excellent sensitivity of 95% (95% CI 77% to 100%) and 100% (95% CI 81% to 100%) in all children and in children aged >2 years, respectively. The specificity, however, was 34% (95% CI 27% to 36%) and 37% (95% CI 30% to 37%), respectively. CONCLUSIONS S100B has an excellent sensitivity but poor specificity. It is therefore an accurate tool to help rule out an intracranial injury but cannot be used as the sole marker owing to its specificity. Used with clinical decision rules, S100B may help to reduce the number of unnecessary CT scans.
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Affiliation(s)
- Sergio Manzano
- Pediatric Emergency Department, Geneva University Hospital, Geneva, Switzerland
| | | | | | - Laurence Lacroix
- Pediatric Emergency Department, Geneva University Hospital, Geneva, Switzerland
| | - Dagmar Klima-Lange
- Department of Pediatric Surgery, Ostschweizer Children's Hospital, St. Gallen, Switzerland
| | - Martin Hersberger
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital, Zurich, Switzerland
| | - Giorgio La Scala
- Pediatric Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Stefan Altermatt
- Pediatric Surgery Department, University Children's Hospital, Zurich, Switzerland
| | - Georg Staubli
- Pediatric Emergency Department, University Children's Hospital, Zurich, Switzerland
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Soroushmehr SMR, Bafna A, Schlosser S, Ward K, Derksen H, Najarian K. CT image segmentation in traumatic brain injury. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:2973-2976. [PMID: 26736916 DOI: 10.1109/embc.2015.7319016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traumatic brain injury (TBI) is a major cause of disability and death. Speed and accuracy are vital in diagnosing TBI for which computer-aided imaging analysis may speedup and improve the efficiency of diagnosis and help reduce mortality, long-term complications, and the associated costs. However, developing such a system is challenging due to some factors such as the inherent noise associated with obtaining the images, artifacts and quality of the images. An automated system that can preliminary identify, localize and quantify the imaging features of TBI would be beneficial in guiding real-time clinical diagnosis as well as for quality assurance. In this paper we propose an automated system to segment the hematoma region from CT images. The proposed method first performs denoising and image enhancement and then by developing a Gaussian mixture model, segmentation is carried out. We show the performance of the system by comparing the results with ground truth generated by specialists.
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Falcone T, Janigro D, Lovell R, Simon B, Brown CA, Herrera M, Myint AM, Anand A. S100B blood levels and childhood trauma in adolescent inpatients. J Psychiatr Res 2015; 62:14-22. [PMID: 25669696 PMCID: PMC4413930 DOI: 10.1016/j.jpsychires.2014.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/14/2014] [Accepted: 12/04/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Serum levels of the astrocytic protein S100B have been reported to indicate disruption of the blood-brain barrier. In this study, we investigated the relationship between S100B levels and childhood trauma in a child psychiatric inpatient unit. METHOD Levels of S100B were measured in a group of youth with mood disorders or psychosis with and without history of childhood trauma as well as in healthy controls. Study participants were 93 inpatient adolescents admitted with a diagnosis of psychosis (N = 67), or mood disorder (N = 26) and 22 healthy adolescents with no history of trauma or psychiatric illness. Childhood trauma was documented using the Life Events Checklist (LEC) and Adverse Child Experiences (ACE). RESULTS In a multivariate regression model, suicidality scores and trauma were the only two variables which were independently related to serum S100B levels. Patients with greater levels of childhood trauma had significantly higher S100B levels even after controlling for intensity of suicidal ideation. Patients with psychotic diagnoses and mood disorders did not significantly differ in their levels of S100B. Patients exposed to childhood trauma were significantly more likely to have elevated levels of S100B (p < .001) than patients without trauma, and patients with trauma had significantly higher S100B levels (p < .001) when compared to the control group. LEC (p = 0.046), and BPRS-C suicidality scores (p = 0.001) significantly predicted S100B levels. CONCLUSIONS Childhood trauma can potentially affect the integrity of the blood-brain barrier as indicated by associated increased S100B levels.
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Affiliation(s)
- Tatiana Falcone
- Cleveland Clinic, Neurologic Institute, Department of Neurology, 9500 Euclid Avenue, S60, Cleveland, OH 44195, USA; Cleveland Clinic, Neurologic Institute, Department of Psychiatry, 9500 Euclid Avenue, P57, Cleveland, OH 44195, USA.
| | - Damir Janigro
- Cleveland Clinic, Lerner College of Medicine, Cerebrovascular Research NB-20 LRI, 9600 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Rachel Lovell
- Begun Center for Violence Prevention Research and Education, Case Western Reserve University, 11402 Bellflower Road, Cleveland, OH 44106-7167, USA.
| | - Barry Simon
- Cleveland Clinic, Department of Psychiatry, 9500 Euclid Avenue, P57, Cleveland, OH 44195, USA.
| | - Charles A. Brown
- Cleveland Clinic, Department of Psychiatry, 9500 Euclid Avenue, P57, Cleveland, OH 44195, USA
| | - Mariela Herrera
- Cleveland Clinic, Department of Psychiatry, 9500 Euclid Avenue, P57, Cleveland, OH 44195, USA.
| | - Aye Mu Myint
- Laboratory for Psychoneuroimmunology, Psychiatric Hospital Ludwig-Maximilian University, Nussbaumstrasse, 780336 Munich, Germany.
| | - Amit Anand
- Cleveland Clinic, Department of Psychiatry, Center for Behavioral Health, 9500 Euclid Avenue P57, Cleveland, OH 44195, USA.
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Olivecrona Z, Bobinski L, Koskinen LOD. Association of ICP, CPP, CT findings and S-100B and NSE in severe traumatic head injury. Prognostic value of the biomarkers. Brain Inj 2014; 29:446-54. [PMID: 25518864 DOI: 10.3109/02699052.2014.989403] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The association was studied of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) on S-100B and neuron-specific enolase (NSE) in severe traumatic brain injury (sTBI). The relationship was explored between biomarkers, ICP, CPP, CT-scan classifications and the clinical outcome. MATERIALS AND METHODS Data were collected prospectively and consecutively in 48 patients with Glasgow Coma Scale score ≤ 8, age 15-70 years. NSE and S-100B were analysed during 5 consecutive days. The initial and follow-up CT-scans were classified according to the Marshall, Rotterdam and Morris-Marshall classifications. Outcome was evaluated with extended Glasgow outcome scale at 3 months. RESULTS Maximal ICP and minimal CPP correlated with S-100B and NSE levels. Complex relations between biomarkers and CT classifications were observed. S-100B bulk release (AUC = 0.8333, p = 0.0009), and NSE at 72 hours (AUC = 0.8476, p = 0.0045) had the highest prediction power of mortality. Combining Morris-Marshall score and S-100B bulk release improved the prediction of clinical outcome (AUC = 0.8929, p = 0.0008). CONCLUSION Biomarker levels are associated with ICP and CPP and reflect different aspects of brain injury as evaluated by CT-scan. The biomarkers might predict mortality. There are several pitfalls influencing the interpretation of biomarker data in respect to ICP, CPP, CT-findings and clinical outcome.
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Affiliation(s)
- Zandra Olivecrona
- Institution of Pharmacology and Clinical Neuroscience, Department of Neurosurgery, Umeå University , Umeå , Sweden
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Effect of valproic acid and injury on lesion size and endothelial glycocalyx shedding in a rodent model of isolated traumatic brain injury. J Trauma Acute Care Surg 2014; 77:292-7. [PMID: 25058256 DOI: 10.1097/ta.0000000000000333] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In isolated traumatic brain injury (TBI), little is known about the endothelial response and the effects of endothelial glycocalyx shedding. We have previously shown that treatment with valproic acid (VPA) improves outcomes following TBI and hemorrhagic shock.In this model, we hypothesized that severe isolated TBI would cause shedding of the endothelial glycocalyx, as measured by serum syndecan-1 (sSDC-1) levels. We further hypothesized that VPA treatment would reduce this response and reduce lesion size volume. METHODS Forty Sprague-Dawley rats were allocated to TBI + VPA (n = 8), TBI + saline vehicle control infusion (n = 8), sham + saline vehicle control infusion (n = 6), or sham + VPA (n = 8). TBI animals were subjected to severe controlled cortical impact and killed 6 hours after injury. VPA 300 mg/kg was given as an intravenous bolus 30 minutes after injury. Serum samples were analyzed for sSDC-1, and lesion size was determined on Nissl-stained cryosections. RESULTS sSDC-1 was significantly elevated in injured compared with uninjured animals at 3 hours (p = 0.0009) and 6 hours (p = 0.0007) after injury. This effect was significantly more pronounced in the animals treated with VPA (p = 0.019) 3 hours after injury, in which sSDC-1 levels were also significantly inversely correlated with lesion size (ρ = -0.55, p = 0.038).Lesion size was significantly smaller in TBI + VPA (40.45 mm ± 13.83 mm) as compared with vehicle control (59.57 mm ± 16.83 mm) (p = 0.023). CONCLUSION Severe isolated TBI caused shedding of the endothelial glycocalyx. Treatment with VPA was associated with increased glycocalyx shedding and reduced lesion size volume in injured animal.
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Lorton F, Levieux K, Vrignaud B, Hamel O, Jehlé E, Hamel A, Gras-Leguen C. [New recommendations for the management of children after minor head trauma]. Arch Pediatr 2014; 21:790-6. [PMID: 24935453 DOI: 10.1016/j.arcped.2014.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/12/2014] [Accepted: 04/18/2014] [Indexed: 11/28/2022]
Abstract
Minor head trauma is a common cause for pediatric emergency department visits. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) published a clinical prediction rule for identifying children at very low risk of clinically important traumatic brain injuries (ciTBI) and for reducing CT use because of malignancy induced by ionizing radiation. The prediction rule for ciTBI was derived and validated on 42,412 children in a prospective cohort study. The Société Française de Médecine d'Urgence (French Emergency Medicine Society) and the Groupe Francophone de Réanimation et Urgences Pédiatriques (French-Language Pediatric Emergency Care Group) recommend this algorithm for the management of children after minor head trauma. Based on clinical variables (history, symptoms, and physical examination findings), the algorithm assists in medical decision-making: CT scan, hospitalization for observation or discharge, according to three levels of ciTBI risk (high, intermediate, or low risk). The prediction rule sensitivity for children younger than 2 years is 100 % [86.3-100] and for those aged 2 years and older it is 96.8 % [89-99.6]. Our aim is to present these new recommendations for the management of children after minor head trauma.
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Affiliation(s)
- F Lorton
- Urgences pédiatriques, CHU de Nantes, 9, quai Moncousu, 44093 Nantes cedex 1, France.
| | - K Levieux
- Urgences pédiatriques, CHU de Nantes, 9, quai Moncousu, 44093 Nantes cedex 1, France
| | - B Vrignaud
- Urgences pédiatriques, CHU de Nantes, 9, quai Moncousu, 44093 Nantes cedex 1, France
| | - O Hamel
- Neurotraumatologie, CHU de Nantes, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - E Jehlé
- Urgences, hôpital Purpan, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - A Hamel
- Chirurgie orthopédique pédiatrique, hôpital Femme-Enfant-Adolescent, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - C Gras-Leguen
- Urgences pédiatriques, CHU de Nantes, 9, quai Moncousu, 44093 Nantes cedex 1, France
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Babcock L, Byczkowski T, Wade SL, Ho M, Bazarian JJ. Inability of S100B to predict postconcussion syndrome in children who present to the emergency department with mild traumatic brain injury: a brief report. Pediatr Emerg Care 2013; 29:458-61. [PMID: 23528506 PMCID: PMC3623559 DOI: 10.1097/pec.0b013e31828a202d] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to explore the ability of the serum marker S100B to predict the development and severity of postconcussion syndrome (PCS) at 3 months in children after mild traumatic brain injury (mTBI). METHODS This is a retrospective analysis of a prospective observational study conducted in a pediatric emergency department (ED). Children were eligible for the study if they were between the ages 5 and 18 years, presented within 6 hours of injury, met the case definition of mTBI from American Congress of Rehabilitation Medicine, had a Glasgow Coma Scale score of greater than 13, consented to have blood drawn for S100B levels, and completed the 3-month telephone follow-up. At the follow-up, the Rivermead Postconcussion Questionnaire was conducted to determine the development and severity of PCS. RESULTS A total of 76 children were included in this cohort. The children had a mean (SD) age of 14.0 (3.1) years, 60.5% were male, and 89.5% had a Glasgow Coma Scale of 15. Twenty-eight (36.8%) developed PCS. For the children who developed PCS, the mean (SD) S100B level was 0.092 (0.376) µg/L. For children who did not develop PCS (n = 48), the mean (SD) S100B level was 0.022 (0.031) µg/L. The analyses did not support an association between initial S100B levels measured in the ED and development of PCS or severity of PCS symptoms. CONCLUSIONS In this small sample, S100B, measured immediately after injury in the ED, did not seem to predict those children with mTBI who will go on to develop PCS.
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Affiliation(s)
- Lynn Babcock
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2008, Cincinnati, OH 45229, (513) 803-2956 (phone), (513) 636-7967 (fax), , Formerly at: University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Avenue, Box 655, Rochester, NY 14642
| | - Terri Byczkowski
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2008, Cincinnati, OH 45229, (513) 636-0191 (phone), (513) 636-7967 (fax),
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 4009, Cincinnati, OH 45229, (513) 636-3370 (phone), 513-636-7360 (fax),
| | - Mona Ho
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2008, Cincinnati, OH 45229, (513) 803-2637 (phone), (513) 636-7967 (fax),
| | - Jeffrey J Bazarian
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655, Rochester, NY 14642, (585) 463-2928 (phone), (585) 463-2969 (fax),
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