A Neurological Crystal Ball

    Biomarkers may predict traumatic brain injury outcomes.

    When it comes to predicting outcomes following a child’s traumatic brain injury, rehab physicians may have more questions than answers. After all, says Johns Hopkins pediatric physiatrist Stacy Suskauer, symptoms can last from hours to years, “and we lack objective biomarkers with which to predict outcome, inform treatment and evaluate the risk for chronic sequelae.”

    Suskauer, who also directs Brain Injury Rehabilitation Programs at Johns Hopkins’ neighboring Kennedy Krieger Institute, is convinced that biomarkers for those with mild traumatic brain injuries (mTBI) hold the key to understanding how well a child will fare following the injury. In addition, Suskauer says, knowing what to expect early on can help inform treatment decisions that may arise after the trauma, such as whether or not to start a medication to help prevent headaches.

    The current management approach, “based on consensus but little evidence,” says Suskauer, is wait-and-see; children are told to rest from physical and cognitive activities. “But for the 50 percent of children who remain symptomatic one month after the injury, more aggressive intervention earlier after concussion may speed recovery.”

    Eager to change the status quo, the young investigator has launched a study to evaluate biomarkers of children who suffer mild traumatic brain injury to predict outcomes and to better understand recovery. To that end, Suskauer and her colleagues at the Johns Hopkins Brain Sciences Institute plan to test the value of blood glial fibrillary acidic protein (GFAP) and novel urine biomarkers obtained shortly after mTBI.

    GFAP, explains Suskauer, is a well-established serum biomarker of severe TBI that has recently been associated with acute markers of injury severity in adults with mTBI. And, though detection of urine biomarkers has not been established as a diagnostic technique for TBI as yet, she notes, single-subject data demonstrates qualitatively increased novel urine biomarkers after severe TBI.

    Over the next two years, the research team will obtain blood and urine from 250 emergency department patients, ages 0 to 17, with acute TBI who receive an IV or have blood drawn as part of medical management. Blood will be taken every two hours, and outcomes will be assessed in follow-up phone interviews with parents, using the Post-Concussion Symptom Inventory.

    Within seven months after enrollment begins, says Suskauer, the team expects to have follow-up outcome data on at least 35 children. To meet recruitment goals, she adds, they may encourage other EDs to participate as well. But regardless of how long it takes to fully understand the role of these biomarkers for predicting longer-term outcomes, Suskauer looks forward to the day she can offer parents a better sense of what to expect—and guide meaningful interventions.

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