Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Medical College of Georgia, Augusta, Georgia, USA.
J Neurotrauma. 2020 Oct 1;37(19):2029-2044. doi: 10.1089/neu.2019.6956. Epub 2020 Jun 2.
Public concern is growing about the short- and long-term effects of pediatric mild traumatic brain injury (mTBI). This concern is amplified because pediatric mTBI has the potential to go undiagnosed in acute care settings, placing children at increased risk for reinjury prior to complete recovery. The management of mTBI can be particularly challenging due to the lack of validated biomarkers that clinicians can use to objectively diagnose pediatric mTBI, predict risk for prolonged recovery, or demonstrate mTBI recovery. Fluid-based biomarkers have drawn increased attention as an objective measure to diagnose and manage pediatric mTBI, but investigations of promising biomarkers may pose unique challenges in pediatric populations. Our systematic review confirms the relative paucity of high-quality, clinically impactful diagnostic or prognostic fluid biomarker studies, on samples representing only a small fraction of pediatric mTBI. Ultimately, well-designed longitudinal studies across diverse points of care are needed to truly characterize the utility of fluid biomarkers of injury and recovery for the pediatric mTBI patient.
公众越来越关注儿科轻度创伤性脑损伤 (mTBI) 的短期和长期影响。这种担忧加剧了，因为儿科 mTBI 有可能在急性护理环境中未被诊断出来，使儿童在完全康复之前面临再次受伤的风险增加。由于缺乏临床医生可用于客观诊断儿科 mTBI、预测延长恢复期风险或证明 mTBI 恢复的经过验证的生物标志物，mTBI 的管理可能特别具有挑战性。基于液体的生物标志物作为诊断和管理儿科 mTBI 的客观指标引起了越来越多的关注，但对有前途的生物标志物的研究可能会在儿科人群中带来独特的挑战。我们的系统评价证实了高质量、具有临床意义的诊断或预后液体生物标志物研究相对较少，这些研究仅针对儿科 mTBI 的一小部分样本。最终，需要在不同的护理点进行精心设计的纵向研究，以真正描述损伤和恢复的液体生物标志物对儿科 mTBI 患者的效用。
