Research Reports - Systematic review of clinical research on biomarkers for pediatric traumatic brain injury

J Neurotrauma. 2012 Oct 18

Papa L, Ramia MM, Kelly JM, Burks SS, Pawlowicz A, Berger RP

The objective was to systematically review the medical literature and
comprehensively summarize clinical research done on biomarkers for pediatric
traumatic brain injury (TBI) and to summarize the studies that have assessed
serum biomarkers acutely in determining intracranial lesions on CT in children
with TBI. The search strategy included a literature search of PubMed®, MEDLINE®
and the Cochrane Database from 1966 to August 2011, as well as a review of
reference lists of identified studies. Search terms used included pediatrics,
children, traumatic brain injury, and biomarkers. Any article with biomarkers of
traumatic brain injury as a primary focus and containing a pediatric population
was included. The search initially identified 167 articles. Of these, 49 met
inclusion and exclusion criteria and were critically reviewed. The median sample
size was 58 [IQR 31-101]. The majority of the articles exclusively studied
children 36 (74%) and 13 (26%) were studies that included both children and
adults in different proportions. There were 99 different biomarkers measured in
these 49 studies and the five most frequently examined biomarkers were S100B (27
studies), NSE (15 studies), IL-6 (7 studies), MBP (6 studies), and IL-8 (6
studies). There were 6 studies that assessed the relationship between serum
markers and CT lesions. Two studies found that NSE levels ≥ 15 ng/ml within 24
hours of TBI was associated with intracranial lesions. Four studies using serum
S100B were conflicting: 2 studies found no association with intracranial lesions
and 2 studies found a weak association. The flurry of research in the area over
the last decade is encouraging but is limited by small sample sizes, variable
practices in sample collection, inconsistent biomarker-related data elements and
disparate outcome measures. Future studies of biomarkers for pediatric TBI will
require rigorous and more uniform research methodology, common data elements, and
consistent performance measures.

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