Submitted:

04 February 2025

Posted:

05 February 2025

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Abstract
Background: Mild traumatic brain injury (mTBI) in children is a public health concern resulting in one of the main causes of pediatric emergency department (PED) visits. However, the acute care of mTBI patients remains challenging due to the limited use of specific and safe diagnostic tools. Objectives: To evaluate the performances of combined blood biomarkers to safely rule out intracranial injuries in children with mTBI in the PED. Methods: This was a prospective multicenter cohort study of children aged 0-16 years who presented to the PED within 24 hours of sustaining mTBI. Blood was drawn at admission and levels of IL6, NfL, NTproBNP, GFAP, IL10, S100b, and HFABP were analyzed. Patients were dichotomized in two groups: 1) with intracranial injuries (ICI) on computed tomography scan (CT) (= CT+) and 2) without ICI on CT or kept in observation without CT (= CT- & Obs.). Biomarker age correlation was assessed in a healthy group of children aged 0-16 years. Results: 419 children with mTBI and 99 healthy children were enrolled. All the single and duplex combinations of blood-biomarkers were tested for their capacity to safely rule out intracranial injuries. IL6 was present in the three best combinations reaching 100% sensitivity (SE) and with the highest associated specificity (SP). IL6 + NfL yielded 61% SP, followed by IL6 + NTproBNP with 60% SP, and IL6 + GFAP with 57% SP. Neither IL6 nor NTproBNP were found to be age correlated. Conclusions: IL6 in combination with either NfL, NTproBNP, or GFAP could safely rule out 61% of children without ICI (corresponding to 33/79 unnecessary CT scans and 212/322 observation stays at PED). Blood panels incorporating IL6 show promise as decision-making tools for the acute management of children with mTBI. However, further external studies are required to validate these findings.
Keywords: 
biomarker; combination; mTBI; pediatric; rule out; children; emergency
Subject: 
Medicine and Pharmacology  -   Emergency Medicine
Copyright: This open access article is published under a Creative Commons CC BY 4.0 license, which permit the free download, distribution, and reuse, provided that the author and preprint are cited in any reuse.

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