Biomarkers for the Clinical Differential Diagnosis in Traumatic Brain Injury—A Systematic Review

• Published in: CNS neuroscience & therapeutics Vol. 19; no. 8; pp. 556 - 565
• Main Authors: Yokobori, Shoji, Hosein, Khadil, Burks, Stephen, Sharma, Ishna, Gajavelli, Shyam, Bullock, Ross
• Format: Journal Article
• Language: English
• Published: Oxford Wiley-Blackwell 01-08-2013; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Animals; Biological and medical sciences; Biomarkers; Biomarkers - metabolism; Brain damage; Brain Injuries - diagnosis; Brain Injuries - enzymology; Brain Injuries - metabolism; Brain research; Decision making; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Diagnosis, Differential; Differential diagnosis; Glial fibrillary acidic protein; Glial Fibrillary Acidic Protein - metabolism; Head injuries; Humans; Hydrolase; Hypertension; Injuries of the nervous system and the skull. Diseases due to physical agents; Intracranial hypertension; Medical sciences; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Neuronal-glial interactions; Pathophysiology; Phosphopyruvate hydratase; Phosphopyruvate Hydratase - metabolism; Polypeptides; Proteins; Review; S100 Calcium Binding Protein beta Subunit - metabolism; Spectrin; Spectrin - metabolism; Systematic review; Tau protein; tau Proteins - metabolism; Traumas. Diseases due to physical agents; Traumatic brain injury; Ubiquitin; Ubiquitin Thiolesterase - metabolism; Nervous system diseases; Traumatic brain injury; Pathophysiology; Intracranial hypertension; Central nervous system disease; Biomarkers; Differential diagnosis; Head trauma; Differential diagnostic; Cerebral disorder
• ISSN: 1755-5930; 1755-5949
• DOI: 10.1111/cns.12127

Summary
Rapid triage and decision‐making in the treatment of traumatic brain injury (TBI) present challenging dilemma in “resource poor” environments such as the battlefield and developing areas of the world. There is an urgent need for additional tools to guide treatment of TBI. The aim of this review is to establish the possible use of diagnostic TBI biomarkers in (1) identifying diffuse and focal brain injury and (2) assess their potential for determining outcome, intracranial pressure (ICP), and responses to therapy. At present, there is insufficient literature to support a role for diagnostic biomarkers in distinguishing focal and diffuse injury or for accurate determination of raised ICP. Presently, neurofilament (NF), S100β, glial fibrillary acidic protein (GFAP), and ubiquitin carboxyl terminal hydrolase‐L1 (UCH‐L1) seemed to have the best potential as diagnostic biomarkers for distinguishing focal and diffuse injury, whereas C‐tau, neuron‐specific enolase (NSE), S100β, GFAP, and spectrin breakdown products (SBDPs) appear to be candidates for ICP reflective biomarkers. With the combinations of different pathophysiology related to each biomarker, a multibiomarker analysis seems to be effective and would likely increase diagnostic accuracy. There is limited research focusing on the differential diagnostic properties of biomarkers in TBI. This fact warrants the need for greater efforts to innovate sensitive and reliable biomarkers. We advocate awareness and inclusion of the differentiation of injury type and ICP elevation in further studies with brain injury biomarkers.