Serum neuron-specific enolase, S100B, and myelin basic protein concentrations after inflicted and noninflicted traumatic brain injury in children. J Neurosurg 2005 Jul;103(1 Suppl):61-8
Date
08/27/2005Pubmed ID
16122007DOI
10.3171/ped.2005.103.1.0061Scopus ID
2-s2.0-26044445222 (requires institutional sign-in at Scopus site) 230 CitationsAbstract
OBJECT: Misdiagnosis of inflicted traumatic brain injury (iTBI) is common. Serum biomarkers may be able to assist in the detection of iTBIs that would otherwise be missed. The authors investigated whether serum concentrations of biomarkers were increased after noninflicted (n)TBI and iTBI in pediatric cases of varying severity.
METHODS: This prospective, case-control study involved 100 patients (56 with nTBI, 44 with iTBI) and 64 controls. Blood was collected in patients within 12 hours of injury; a subset had serial samples. A single sample was collected from controls. Serum neuron-specific enolase (NSE), S100B, and myelin basic protein concentrations were measured. Abnormal concentrations were defined using receiver-operator characteristic (ROC) curves. The sensitivity and specificity of initial NSE and S100B and peak myelin basic protein concentrations for identifying TBI at ROC curve-defined cutoffs were 71 and 64% (NSE), 77 and 72% (S100B), and 44 and 96% (myelin basic protein), respectively. Eighty-six percent of patients having suffered iTBI had one or more biomarkers increased, including 82% of children with iTBI and a Glasgow Coma Scale score of 15, and two children with iTBI who were initially misdiagnosed. Children with iTBI had a later peak concentration of all three biomarkers and were more likely to have increased myelin basic protein levels at admission compared with patients with nTBI.
CONCLUSIONS: Serum NSE, S100B, or myelin basic protein are increased in the majority of children with acute nTBI and iTBI, including well-appearing children with iTBI in whom the diagnosis might otherwise have been missed. Differences in the time course of NSE, S100B, and myelin basic protein after nTBI and iTBI may provide insight into the pathophysiology of iTBI. These serum markers should be prospectively evaluated in a target population of infants.
Author List
Berger RP, Adelson PD, Pierce MC, Dulani T, Cassidy LD, Kochanek PMAuthor
Laura Cassidy PhD Associate Dean, Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
BiomarkersBrain Injuries
Case-Control Studies
Child
Child Abuse
Child, Preschool
Female
Glasgow Coma Scale
Humans
Infant
Infant, Newborn
Injury Severity Score
Male
Myelin Basic Protein
Nerve Growth Factors
Phosphopyruvate Hydratase
Prospective Studies
S100 Calcium Binding Protein beta Subunit
S100 Proteins
