Research Reports - Brain biomarkers and pre-injury cognition are associated with long-term cognitive outcome in children with traumatic brain injury

BMC Pediatr. 2017 Jul 24;17(1):173. doi: 10.1186/s12887-017-0925-6.

Wilkinson AA(1)(2), Dennis M(3)(4)(5), Simic N(6), Taylor MJ(3)(4)(7), Morgan
BR(7), Frndova H(8), Choong K(9), Campbell C(10), Fraser D(10), Anderson
V(11)(12), Guerguerian AM(4)(8), Schachar R(4)(13), Hutchison J(14)(15); Canadian
Critical Care Trials Group (CCCTG); Canadian Critical Care Translational Biology
Group (CCCTBG).

BACKGROUND: Children with traumatic brain injury (TBI) are frequently at risk of
long-term impairments of attention and executive functioning but these problems
are difficult to predict. Although deficits have been reported to vary with
injury severity, age at injury and sex, prognostication of outcome remains
imperfect at a patient-specific level. The objective of this proof of principle
study was to evaluate a variety of patient variables, along with six
brain-specific and inflammatory serum protein biomarkers, as predictors of
long-term cognitive outcome following paediatric TBI.
METHOD: Outcome was assessed in 23 patients via parent-rated questionnaires
related to attention deficit hyperactivity disorder (ADHD) and executive
functioning, using the Conners 3rd Edition Rating Scales (Conners-3) and
Behaviour Rating Inventory of Executive Function (BRIEF) at a mean time since
injury of 3.1 years. Partial least squares (PLS) analyses were performed to
identify factors measured at the time of injury that were most closely associated
with outcome on (1) the Conners-3 and (2) the Behavioural Regulation Index (BRI)
and (3) Metacognition Index (MI) of the BRIEF.
RESULTS: Higher levels of neuron specific enolase (NSE) and lower levels of
soluble neuron cell adhesion molecule (sNCAM) were associated with higher scores
on the inattention, hyperactivity/impulsivity and executive functioning scales of
the Conners-3, as well as working memory and initiate scales of the MI from the
BRIEF. Higher levels of NSE only were associated with higher scores on the
inhibit scale of the BRI.
CONCLUSIONS: NSE and sNCAM show promise as reliable, early predictors of
long-term attention-related and executive functioning problems following
paediatric TBI. 

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