Pediatric TBI: can serum tau improve diagnosis?

  • Lancet Child Adolesc Health

  • von Susan London
  • Clinical Essentials
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Takeaway

  • In pediatric patients with traumatic brain injury (TBI), serum total tau level on the first day was inversely associated with Glasgow Coma Scale (GCS) score and discriminated between subgroups with mild TBI.

Why this matters

  • Need for noninvasive biomarkers to improve diagnosis.

Key results

  • Inverse association seen between tau level on day 1 and GCS score (rs, –0.42; P<.0001>
  • Compared with control group, median total tau (2.46 pg/mL):
    • 2.86 pg/mL with GCS 13-15 (P<.0001>
    • 7.08 pg/mL with GCS 9-12 (P<.0001>
    • 8.48 pg/mL with GCS 3-8 (P<.0001>
  • Within mild TBI group, level vs control:
    • Similar for GCS 15 group (2.57 pg/mL; P=NS).
    • Elevated for GCS 13-14 group (6.41 pg/mL; P=.014).
  • Diagnostic accuracy for TBI, area under curve:
    • 0.499 (P=.98) for GCS 15 group.
    • 0.787 (P=.0036) for GCS 13-14 group.
    • 0.89 (P<.0001 for gcs group.>
    • 0.73 (P<.0001 for gcs group.>
  • Within mild TBI group, there was only moderate correlation of level with CT findings (abnormal vs normal).

Expert comment

  • In a comment, Naomi Ketharanathan, MD, and colleagues write that “it is prudent not to prematurely extrapolate preclinical data to a clinical context. Important steps in biomarker translational research include the continued discovery of biomarkers; establishing validated normative data across the paediatric age span; generating standardised protocols for sample collection, processing, and analysis; guaranteeing quality control of test assay performance before clinical application; and establishing a clear association between biomarkers and clinical endpoints.”

Study design

  • Multinational case-control study:
    • 416 healthy children in reference biobank.
    • 158 children with TBI aged 0-17 years presenting to emergency department within 24 hours.
  • Main outcomes: normative levels; diagnostic performance.
  • Funding: Canadian Institutes of Health Research; others.

Limitations

  • Samples collected in independent studies.
  • Control group did not exclude orthopedic injury.
  • Fewer moderate, severe TBIs.