Cerebrospinal fluid biomarkers versus Glasgow Coma Scale and Glasgow Outcome Scale in pediatric traumatic brain injury: The role of young age and inflicted injury

Paul M. Shore, Rachel P. Berger, Sumeeta Varma, Keri L. Janesko, Stephen R. Wisniewski, Robert S B Clark, P. David Adelson, Neal J. Thomas, Yi Chen Lai, Hülya Bayir, Patrick M. Kochanek

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48 Citations (Scopus)

Abstract

The Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) are widely used clinical scoring systems to measure the severity of neurologic injury after traumatic brain injury (TBI), but have recognized limitations in infants and small children. Cerebrospinal fluid (CSF) concentrations of neuron-specific enolase (NSE) and S100B show promise as markers of brain injury. We hypothesized that the initial GCS and 6-month GOS scores would be inversely associated with CSF NSE and/or S100B concentrations after severe pediatric TBI. Using banked CSF obtained during ongoing studies of pediatric TBI, NSE and S100B were determined in CSF collected within 24 h of trauma from 88 infants and children with severe TBI (GCS ≤ 8) versus 20 non-injured controls. Victims of inflicted (iTBI) and non-inflicted TBI (nTBI) showed similar (>10-fold) increases in both NSE and S100B versus control. Both markers showed overall significant, inverse correlation with GCS and GOS scores. In subgroup analysis, both markers correlated significantly with GCS and GOS scores only in older (>4 years) victims of nTBI; no correlation was found for patients ≤4 years old or victims of iTBI. While confirming the overall correlations between GCS/GOS score and CSF NSE and S100B seen in prior studies, we conclude that these clinical and CSF biomarkers of brain injury do not correlate in children ≤4 years of age and/or victims of iTBI. Although further, prospective study is warranted, these findings suggest important limitations in our current ability to assess injury severity in this important population.

Original languageEnglish (US)
Pages (from-to)75-86
Number of pages12
JournalJournal of Neurotrauma
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2007

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Glasgow Outcome Scale
Glasgow Coma Scale
Phosphopyruvate Hydratase
Cerebrospinal Fluid
Biomarkers
Pediatrics
Wounds and Injuries
Brain Injuries
Nervous System Trauma
Traumatic Brain Injury
Prospective Studies
Population

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Shore, Paul M. ; Berger, Rachel P. ; Varma, Sumeeta ; Janesko, Keri L. ; Wisniewski, Stephen R. ; Clark, Robert S B ; Adelson, P. David ; Thomas, Neal J. ; Lai, Yi Chen ; Bayir, Hülya ; Kochanek, Patrick M. / Cerebrospinal fluid biomarkers versus Glasgow Coma Scale and Glasgow Outcome Scale in pediatric traumatic brain injury : The role of young age and inflicted injury. In: Journal of Neurotrauma. 2007 ; Vol. 24, No. 1. pp. 75-86.
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abstract = "The Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) are widely used clinical scoring systems to measure the severity of neurologic injury after traumatic brain injury (TBI), but have recognized limitations in infants and small children. Cerebrospinal fluid (CSF) concentrations of neuron-specific enolase (NSE) and S100B show promise as markers of brain injury. We hypothesized that the initial GCS and 6-month GOS scores would be inversely associated with CSF NSE and/or S100B concentrations after severe pediatric TBI. Using banked CSF obtained during ongoing studies of pediatric TBI, NSE and S100B were determined in CSF collected within 24 h of trauma from 88 infants and children with severe TBI (GCS ≤ 8) versus 20 non-injured controls. Victims of inflicted (iTBI) and non-inflicted TBI (nTBI) showed similar (>10-fold) increases in both NSE and S100B versus control. Both markers showed overall significant, inverse correlation with GCS and GOS scores. In subgroup analysis, both markers correlated significantly with GCS and GOS scores only in older (>4 years) victims of nTBI; no correlation was found for patients ≤4 years old or victims of iTBI. While confirming the overall correlations between GCS/GOS score and CSF NSE and S100B seen in prior studies, we conclude that these clinical and CSF biomarkers of brain injury do not correlate in children ≤4 years of age and/or victims of iTBI. Although further, prospective study is warranted, these findings suggest important limitations in our current ability to assess injury severity in this important population.",
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Shore, PM, Berger, RP, Varma, S, Janesko, KL, Wisniewski, SR, Clark, RSB, Adelson, PD, Thomas, NJ, Lai, YC, Bayir, H & Kochanek, PM 2007, 'Cerebrospinal fluid biomarkers versus Glasgow Coma Scale and Glasgow Outcome Scale in pediatric traumatic brain injury: The role of young age and inflicted injury', Journal of Neurotrauma, vol. 24, no. 1, pp. 75-86. https://doi.org/10.1089/neu.2006.0062

Cerebrospinal fluid biomarkers versus Glasgow Coma Scale and Glasgow Outcome Scale in pediatric traumatic brain injury : The role of young age and inflicted injury. / Shore, Paul M.; Berger, Rachel P.; Varma, Sumeeta; Janesko, Keri L.; Wisniewski, Stephen R.; Clark, Robert S B; Adelson, P. David; Thomas, Neal J.; Lai, Yi Chen; Bayir, Hülya; Kochanek, Patrick M.

In: Journal of Neurotrauma, Vol. 24, No. 1, 01.01.2007, p. 75-86.

Research output: Contribution to journalArticle

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AU - Shore, Paul M.

AU - Berger, Rachel P.

AU - Varma, Sumeeta

AU - Janesko, Keri L.

AU - Wisniewski, Stephen R.

AU - Clark, Robert S B

AU - Adelson, P. David

AU - Thomas, Neal J.

AU - Lai, Yi Chen

AU - Bayir, Hülya

AU - Kochanek, Patrick M.

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N2 - The Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) are widely used clinical scoring systems to measure the severity of neurologic injury after traumatic brain injury (TBI), but have recognized limitations in infants and small children. Cerebrospinal fluid (CSF) concentrations of neuron-specific enolase (NSE) and S100B show promise as markers of brain injury. We hypothesized that the initial GCS and 6-month GOS scores would be inversely associated with CSF NSE and/or S100B concentrations after severe pediatric TBI. Using banked CSF obtained during ongoing studies of pediatric TBI, NSE and S100B were determined in CSF collected within 24 h of trauma from 88 infants and children with severe TBI (GCS ≤ 8) versus 20 non-injured controls. Victims of inflicted (iTBI) and non-inflicted TBI (nTBI) showed similar (>10-fold) increases in both NSE and S100B versus control. Both markers showed overall significant, inverse correlation with GCS and GOS scores. In subgroup analysis, both markers correlated significantly with GCS and GOS scores only in older (>4 years) victims of nTBI; no correlation was found for patients ≤4 years old or victims of iTBI. While confirming the overall correlations between GCS/GOS score and CSF NSE and S100B seen in prior studies, we conclude that these clinical and CSF biomarkers of brain injury do not correlate in children ≤4 years of age and/or victims of iTBI. Although further, prospective study is warranted, these findings suggest important limitations in our current ability to assess injury severity in this important population.

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