Are UCH-L1 and GFAP promising biomarkers for children with mild traumatic brain injury?

Abstract

Objectives: To compare serum biomarker levels between children with mild traumatic brain injury (mTBI) and orthopaedic injury (OI), acutely following injury. Secondarily, to explore the association between biomarker levels and symptom burden over 1 month post-injury.

Methods: This was a prospective cohort study of children aged 11–16 years who presented to the emergency department within 6 hours of sustaining mTBI or isolated extremity OI. Serum was drawn at the time of study enrollment and levels of ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) and glial fibrillary acid protein (GFAP) were analysed. Symptom burden was assessed by the Post-Concussion Symptom Scale (PCSS) acutely following injury and at three subsequent time points over 1 month.

Results: Twenty-five children with mTBI and 20 children with OI were enrolled. The average age for the overall cohort was 13 (± 1.6) years and the majority were male and injured playing sports. GFAP levels and PCSS scores were significantly higher acutely following mTBI vs OI (p < 0.01). There was not a significant group difference in UCH-L1 levels. Neither GFAP nor UCH-L1 were predictive of PCSS scores over the 1month post-injury.

Conclusions: GFAP may be a promising diagnostic tool for children with mTBI. Additional approaches are needed to predict symptom severity and persistence.

Keywords:

• Paediatric
• concussion
• biomarkers
• diagnosis

Acknowledgements

The authors would like to acknowledge the following people for their contributions: Jeff Bazarian, MD, MPH (Scientific Advisor, Department of Emergency Medicine, University of Rochester Medical Center); Terri Byczkowski, PhD, MBA (Scientific Advisor, Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center); Richard Hornung, PhD (Statistical Oversight, Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center); Blaise Jones, MD (Clinical Neuroradiologist, Division of Radiology, Cincinnati Children’s Hospital Medical Center); Lynn Mullins, BA (Data Manager, Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center); Brad Kurowski, MD, MS (Patient Care, Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center); Richard Ruddy, MD (Division Chair, Scientific Advisor, Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center); Imaging Research Coordinators at the Pediatric Neuroimaging Research Consortium at the Cincinnati Children’s Hospital Medical Center (Data Collection); and the Pediatric Emergency Medicine Physicians and Clinical Research Coordinators in the Division of Pediatric Emergency Medicine at Cincinnati Children’s Hospital Medical Center (Data Collection, Data Entry).

Declaration of interest

This study was funded in part by (1) National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2 TR000078 (KL2 RR026315) (Babcock); and (2) Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine. The additional authors have no funding sources or conflicts to disclose for this work.