From the Department of Emergency Medicine, Phoenix Children's Hospital.
Department of Pediatrics, Arizona Children's Center.
Pediatr Emerg Care. 2021 Dec 1;37(12):e1373-e1376. doi: 10.1097/PEC.0000000000002050.
The highest rates of traumatic brain injury (TBI)-related morbidity and mortality occur in young children and adolescents. The objective of this study was to describe the levels of 3 biomarkers (S100B, glial fibrillary acidic protein, neuron-specific enolase) in saliva of children with TBI requiring inpatient admission at a pediatric trauma center and compare these levels in children without TBI.
A convenience sample of 24 children aged 0 to 18 years, presenting with acute isolated TBI, was enrolled prospectively. The non-TBI comparison groups consisted of patients with medical complaints and musculoskeletal injuries only. Salivary specimens were collected, and biomarkers were measured using quantitative enzyme-linked immunosorbent assay method. Demographic, clinical data, and brain imaging findings were obtained.
Seventy-four children were enrolled. Twenty-four had TBI (mean age, 5.07 years; SD, 4.8 years); 14 subjects (58.3%) with TBI were found to have significant traumatic brain injury (SBI) on computed tomography scan. S100B levels were significantly higher in TBI group compared with those with musculoskeletal injury only (median, 113.2 pg/mL vs 18 pg/mL; P = 0.021). Area under the receiver operating characteristic curve for S100B in predicting SBI was 0.675; the optimum threshold for S100B to achieve the optimum sensitivity and specificity of SBI was at 86.9 pg/mL for SBI versus no injury group.
S100B levels in saliva were higher in children with TBI and may be predictive of SBI identified by presence of computed tomography abnormalities. Larger studies are needed to replicate our findings in using a noninvasive diagnostic measure for children with TBI and SBI.
创伤性脑损伤（TBI）相关发病率和死亡率最高的人群是幼儿和青少年。本研究的目的是描述在儿科创伤中心住院的 TBI 患儿唾液中 3 种生物标志物（S100B、胶质纤维酸性蛋白、神经元特异性烯醇化酶）的水平，并将其与无 TBI 的患儿进行比较。
本研究前瞻性纳入了 24 名年龄在 0 至 18 岁之间、因急性孤立性 TBI 就诊的患儿。非 TBI 对照组由仅患有医疗投诉和肌肉骨骼损伤的患者组成。采集唾液标本，采用定量酶联免疫吸附试验法测量生物标志物。收集人口统计学、临床数据和脑影像学结果。
共纳入 74 名患儿。24 名患儿患有 TBI（平均年龄为 5.07 岁，标准差为 4.8 岁）；14 名 TBI 患儿（58.3%）的计算机断层扫描结果显示有明显的创伤性脑损伤（SBI）。与仅患有肌肉骨骼损伤的患儿相比，TBI 组的 S100B 水平明显更高（中位数为 113.2 pg/mL 比 18 pg/mL；P=0.021）。S100B 预测 SBI 的受试者工作特征曲线下面积为 0.675；S100B 预测 SBI 的最佳阈值为 86.9 pg/mL，用于区分 SBI 组与无损伤组。
TBI 患儿唾液中的 S100B 水平较高，且可能与 CT 异常所识别的 SBI 相关。需要进一步的大样本研究来验证我们的发现，即使用一种非侵入性的诊断方法来诊断 TBI 和 SBI 患儿。
