Research Reports - Serum biomarkers help predict attention problems in critically ill children with traumatic brain injury

Pediatr Crit Care Med. 2016 Jul;17(7):638-648.

Wilkinson AA(1), Simic N, Frndova H, Taylor MJ, Choong K, Fraser D, Campbell C,
Dhanani S, Kuehn S, Beauchamp MH, Farrell C, Anderson V, Guerguerian AM, Dennis
M, Schachar R, Hutchison JS; Attention and Traumatic Brain Injury (ATBI)

OBJECTIVE: To evaluate the association between acute serum biomarkers, and the
changes in attention at 1 year following traumatic brain injury.
DESIGN AND SETTING: A prospective observational and laboratory study conducted in
PICUs at five Canadian children's hospitals.
STUDY POPULATION AND MEASUREMENTS: Fifty-eight patients aged 5 to 17 years with
traumatic brain injury were enrolled in the study. Nine brain-specific and
inflammatory serum protein biomarkers were measured multiple times over the first
week following injury. Attention was measured at "baseline" to represent
pre-injury function and at 1 year following injury using the Conners Third Parent
Rating Scale.
RESULTS: Compared with baseline, there were significantly more clinical symptoms
of inattention at 1 year post injury. The Glasgow Coma Scale score, age at
injury, baseline levels of inattention, and highest levels of serum biomarkers
were used to estimate the probability of developing inattention. These
independent variables were first evaluated individually followed by combinations
of the best predictors using area under the receiver operating characteristic
curve analyses. A combination of high baseline levels of inattention and high
serum levels of the biomarker neuron-specific enolase was the best predictor for
inattention. Glasgow Coma Scale and age at injury were not associated with
inattention at 1 year post injury.
CONCLUSIONS: Combining baseline assessment of attention with measurement of serum
biomarkers shows promise as reliable, early predictors of long-term attention
after childhood traumatic brain injury.

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