Citation

Lo TY, Jones PA, Minns RA. J. Neurotrauma 2010; 27(12): 2139-2145.

Affiliation

Royal Hospital for Sick Children, Department of Paediatric Intensive Care Medicine, Edinburgh, United Kingdom; mils.lo@doctors.org.uk.

Copyright

(Copyright © 2010, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2010.1387

PMID

20858121

Abstract

This study aims to determine if pairing Glasgow Coma Scale (GCS) with serum biomarker levels may achieve higher outcome predictive values than using either GCS or biomarker levels alone in childhood brain trauma. Twenty-eight critically ill children with isolated brain trauma were studied in a prospective observational study. GCS was recorded at two pre-determined time points post-injury. Enzyme-linked immunosorbent assay (ELISA) was used to quantify 8 different serum biomarker levels (S100b, NSE, IL-6, IL-8, IL-10, L-selectin, SICAM, and endothelin) on day 1 post-injury. Glasgow Outcome Score (GOS) was used to assess global outcome at 6 months post-injury. Outcome predictive values of GCS, individual biomarker levels, and paired combinations of GCS and biomarkers were compared using Receiver operator characteristic (ROC) curve analysis and its multivariate extension, Multivariate ROC curve (MutliROC). When using either GCS or individual biomarker levels alone to predict unfavourable outcome, only the PICU discharge summated GCS achieved an area under the ROC curve (AUC) of more than 0.95. This high degree of outcome predictability was also achieved by pairing GCS with a single biomarker level. The most pronounced improvement in outcome prediction was observed by pairing the post-resuscitation summated GCS with the day 1 serum IL-8 level which increased the AUC from 0.78 to 0.98, and the sensitivity and specificity from 75% to 100% and 96% respectively. Paired combinations of GCS and serum biomarker greatly enhanced the accuracy of post-traumatic unfavourable outcome prediction than may be achieved using either GCS or individual biomarker level alone.

Language: en