Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA.
Rowan School of Osteopathic Medicine, Stratford, NJ.
J Pediatr. 2020 Dec;227:170-175. doi: 10.1016/j.jpeds.2020.06.080. Epub 2020 Jul 2.
To examine levels of plasma osteopontin (OPN), a recently described neuroinflammatory biomarker, in children with abusive head trauma (AHT) compared with children with other types of traumatic brain injury (TBI).
The study cohort comprised children aged <4 years diagnosed with TBI and seen in the intensive care unit in a tertiary children's hospital. Patients were classified as having confirmed or suspected AHT or TBI by other mechanisms (eg, motor vehicle accidents), as identified by a Child Protection Team clinician. Serial blood samples were collected at admission and at 24, 48, and 72 hours after admission. Levels of OPN were compared across groups.
Of 77 patients identified, 24 had confirmed AHT, 12 had suspected AHT, and 41 had TBI. There were no differences in the Glasgow Coma Scale score between the patients with confirmed AHT and those with suspected AHT and those with TBI (median score, 4.5 vs 4 and 7; P = .39). At admission to the emergency department, OPN levels were significantly higher in children with confirmed AHT compared with the other 2 groups (mean confirmed AHT, 471.5 ng/mL; median suspected AHT, 322.3 ng/mL; mean TBI, 278.0 ng/mL; P = .03). Furthermore, the adjusted mean trajectory levels of OPN were significantly higher in the confirmed AHT group compared with the other 2 groups across all subsequent time points (P = <.01).
OPN is significantly elevated in children with confirmed AHT compared with those with suspected AHT and those with other types of TBI. OPN expression may help identify children with suspected AHT to aid resource stratification and triage of appropriate interventions for children who are potential victims of abuse.
检测虐待性头部外伤（AHT）患儿与其他类型创伤性脑损伤（TBI）患儿血浆骨桥蛋白（OPN）水平，OPN 是最近描述的神经炎症生物标志物。
研究队列包括在三级儿童医院重症监护病房诊断为 TBI 且年龄<4 岁的儿童。患儿由儿童保护团队临床医生根据其他机制（例如机动车事故）确诊或疑似 AHT 或 TBI 进行分组。入院时及入院后 24、48 和 72 小时采集连续血样。比较各组间 OPN 水平。
共纳入 77 例患儿，24 例确诊 AHT，12 例疑似 AHT，41 例 TBI。确诊 AHT 患儿与疑似 AHT 患儿及 TBI 患儿的格拉斯哥昏迷量表评分无差异（中位数评分，4.5 比 4 和 7；P=0.39）。入院时，确诊 AHT 患儿的 OPN 水平显著高于其他 2 组（均值确诊 AHT 组 471.5ng/ml；中位数疑似 AHT 组 322.3ng/ml；均值 TBI 组 278.0ng/ml；P=0.03）。此外，在所有后续时间点，与疑似 AHT 组和 TBI 组相比，确诊 AHT 组 OPN 水平的调整均值轨迹均显著升高（P<.01）。
与疑似 AHT 患儿和其他类型 TBI 患儿相比，确诊 AHT 患儿的 OPN 水平显著升高。OPN 表达可能有助于识别疑似 AHT 患儿，以便为虐待潜在受害者的患儿分配资源和选择适当的干预措施。
