Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 325-332 (doi:10.1542/10.1542/peds.2005-0711)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (27)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Berger, R. P.
Right arrow Articles by Kochanek, P. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Berger, R. P.
Right arrow Articles by Kochanek, P. M.
Related Collections
Right arrow Neurology & Psychiatry
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Identification of Inflicted Traumatic Brain Injury in Well-Appearing Infants Using Serum and Cerebrospinal Markers: A Possible Screening Tool

Rachel Pardes Berger, MD, MPHa,f, Tina Dulani, BAa, P. David Adelson, MDb,f, John M. Leventhal, MDc, Rudolph Richichi, PhDd and Patrick M. Kochanek, MDe,f

a Department of Pediatrics, Child Advocacy Center
b Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
c Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
d Statistical Analysis and Measurement Consultants, Inc, Lanexa, Virginia
e Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
f Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

OBJECTIVE. Inflicted traumatic brain injury (iTBI) is the leading cause of death from TBI in infants. Misdiagnosis of iTBI is common and results in increased morbidity and mortality. Biomarkers may be able to assist in screening infants who are at high risk for iTBI and whose injury might otherwise be missed. We investigated whether serum and/or cerebrospinal fluid (CSF) concentrations of neuron-specific enolase (NSE), S100B, and myelin-basic protein (MBP) are sensitive and specific for iTBI in high-risk infants.

METHODS. A prospective case-control study was conducted of 98 well-appearing infants who presented with nonspecific symptoms and no history of trauma. Serum or CSF was collected. NSE, S100B, and MBP concentrations were measured by enzyme-linked immunosorbent assay. Abnormal marker concentrations were defined a priori. Patients were followed for 12 months to assess for subsequent abuse.

RESULTS. Fourteen patients received a clinical diagnosis of iTBI. Using preestablished cutoffs, NSE was 77% sensitive and 66% specific and MBP was 36% sensitive and 100% specific for iTBI. S100B was neither sensitive nor specific for iTBI. Five patients who were not identified with iTBI at enrollment were identified at follow-up as being possible victims of abuse; 4 had an increased NSE concentration at enrollment.

CONCLUSIONS. Serum and/or CSF concentrations of NSE and MBP may be useful as a screening test to identify infants who are at increased risk for iTBI and may benefit from additional evaluation with a head computed tomography scan. S100B is neither sensitive nor specific for iTBI in this study population. The ability to identify iTBI that might otherwise be missed has important implications for decreasing the morbidity and the mortality from iTBI.

Key Words: biomarker • blood and CSF • neuron-specific enolase • child abuse • inflicted traumatic brain injury

Abbreviations: iTBI—inflicted traumatic brain injury • CT—computed tomography • CSF—cerebrospinal fluid • NSE—neuron-specific enolase • MBP—myelin-basic protein • ROC—receiver operator curves • CHP—Children's Hospital of Pittsburgh • ED—emergency department • ALTE—apparent life-threatening event • NBI—no brain injury • AUC—area under the curve • SDH—subdural hematoma • BBB—blood-brain barrier

Accepted Jun 1, 2005.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 PediatricsHome page
T. Fujiwara, M. Okuyama, and M. Miyasaka
Characteristics That Distinguish Abusive From Nonabusive Head Trauma Among Young Children Who Underwent Head Computed Tomography in Japan
Pediatrics, October 1, 2008; 122(4): e841 - e847.
[Abstract] [Full Text] [PDF]

Home page
 Arch OphthalmolHome page
V. M. Elner
Ocular Manifestations of Child Abuse
Arch Ophthalmol, August 1, 2008; 126(8): 1141 - 1142.
[Full Text] [PDF]