Chiollaz Anne-Cécile, Pouillard Virginie, Spigariol Fabian, Romano Fabrizio, Seiler Michelle, Ritter Schenk Céline, Korff Christian, Habre Céline, Maréchal Fabienne, Wyss Verena, Gruaz Lyssia, Lamana-Vallverdu Marcel, Chocano Elvira, Sempere Bordes Lluis, Luaces-Cubells Carlos, Méndez-Hernández María, Alonso Cadenas José Antonio, Carpio Linde María José, de la Torre Sanchez Paula
Internal Medicine Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Pediatric Neurology Unit, Woman, Child and Adolescent Department, Geneva University Hospitals, Geneva, Switzerland.
Neurotrauma Rep. 2024 May 31;5(1):529-539. doi: 10.1089/neur.2024.0027. eCollection 2024.
Children are highly vulnerable to mild traumatic brain injury (mTBI). Blood biomarkers can help in their management. This study evaluated the performances of biomarkers, in discriminating between children with mTBI who had intracranial injuries (ICIs) on computed tomography (CT+) and (1) patients without ICI (CT-) or (2) both CT- and in-hospital-observation without CT patients. The aim was to rule out the need of unnecessary CT scans and decrease the length of stay in observation in the emergency department (ED). Newborns to teenagers (≤16 years old) with mTBI (Glasgow Coma Scale > 13) were included. S100b, glial fibrillary acidic protein (GFAP), and heart fatty-acid-binding protein (HFABP) performances to identify patients without ICI were evaluated through receiver operating characteristic curves, where sensitivity was set at 100%. A total of 222 mTBI children sampled within 6 h since their trauma were reported. Nineteen percent ( = 43/222) underwent CT scan examination, whereas the others ( = 179/222) were kept in observation at the ED. Sixteen percent ( = 7/43) of the children who underwent a CT scan had ICI, corresponding to 3% of all mTBI-included patients. When sensibility (SE) was set at 100% to exclude all patients with ICI, GFAP yielded 39% specificity (SP), HFABP 37%, and S100b 34% to rule out the need of CT scans. These biomarkers were even more performant: 52% SP for GFAP, 41% for HFABP, and 39% for S100b, when discriminating CT+ versus both in-hospital-observation and CT- patients. These markers can significantly help in the management of patients in the ED, avoiding unnecessary CT scans, and reducing length of stay for children and their families.
儿童极易受到轻度创伤性脑损伤（mTBI）的影响。血液生物标志物有助于对他们进行治疗。本研究评估了生物标志物在鉴别CT检查显示有颅内损伤（ICI）的mTBI儿童与（1）无ICI的患者（CT-）或（2）CT-以及未进行CT检查但在医院观察的患者之间的表现。目的是排除不必要的CT扫描需求，并缩短在急诊科（ED）的观察时间。纳入了患有mTBI（格拉斯哥昏迷量表>13）的新生儿至青少年（≤16岁）。通过将敏感性设定为100%的受试者工作特征曲线，评估了S100b、胶质纤维酸性蛋白（GFAP）和心脏脂肪酸结合蛋白（HFABP）鉴别无ICI患者的表现。共报告了222名在创伤后6小时内采样的mTBI儿童。19%（=43/222）接受了CT扫描检查，而其他儿童（=179/222）在ED接受观察。接受CT扫描的儿童中有16%（=7/43）有ICI，占所有纳入mTBI患者的3%。当将敏感性（SE）设定为100%以排除所有有ICI的患者时，GFAP的特异性（SP）为39%，HFABP为37%，S100b为34%，以排除CT扫描需求。在鉴别CT+与住院观察患者及CT-患者时，这些生物标志物表现更佳：GFAP的SP为52%，HFABP为41%，S100b为39%。这些标志物可显著帮助ED患者的治疗，避免不必要的CT扫描，并减少儿童及其家庭的住院时间。
