Patterns of Osteopontin Expression in Abusive Head Trauma Compared with Other Causes of Pediatric Traumatic Brain Injury

• Type of Material: Article
• Authors: Laura Blackwell, Emory University; Margaret Martinez, Rowan School of Osteopathic Medicine; Ashley Fournier-Goodnight, Emory University; Janet Figueroa, Emory University; Andrew Appert, Childrens Healthcare of Atlanta; Atul Vats, Emory University; Bushra Wali, Emory University; Iqbal Sayeed, Emory University; Andrew Reisner, Emory University
• Language: English
• Date: 2020-12-01
• Publisher: MOSBY-ELSEVIER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2020.06.080
• Title of Journal or Parent Work: JOURNAL OF PEDIATRICS
• Volume: 227
• Start Page: 170
• End Page: 175
• Grant/Funding Information: Funded by the National Institutes of Health (5R21NS103507-02). The data in this article are the basis for patent 62/742,011, Blood Biomarkers for Severe Traumatic Brain Injury, filed on October 5, 2018. The authors declare no conflicts of interest.
• Keywords: CHILDREN; MACROPHAGE; MARKERS; Pediatrics; Science & Technology; Life Sciences & Biomedicine; SERUM BIOMARKER CONCENTRATIONS; OUTCOMES; INFANTS

Abstract

Objective: To examine levels of plasma osteopontin (OPN), a recently described neuroinflammatory biomarker, in children with abusive head trauma (AHT) compared with children with other types of traumatic brain injury (TBI). Study design: The study cohort comprised children aged <4 years diagnosed with TBI and seen in the intensive care unit in a tertiary children's hospital. Patients were classified as having confirmed or suspected AHT or TBI by other mechanisms (eg, motor vehicle accidents), as identified by a Child Protection Team clinician. Serial blood samples were collected at admission and at 24, 48, and 72 hours after admission. Levels of OPN were compared across groups. Results: Of 77 patients identified, 24 had confirmed AHT, 12 had suspected AHT, and 41 had TBI. There were no differences in the Glasgow Coma Scale score between the patients with confirmed AHT and those with suspected AHT and those with TBI (median score, 4.5 vs 4 and 7; P =.39). At admission to the emergency department, OPN levels were significantly higher in children with confirmed AHT compared with the other 2 groups (mean confirmed AHT, 471.5 ng/mL; median suspected AHT, 322.3 ng/mL; mean TBI, 278.0 ng/mL; P =.03). Furthermore, the adjusted mean trajectory levels of OPN were significantly higher in the confirmed AHT group compared with the other 2 groups across all subsequent time points (P = <.01). Conclusions: OPN is significantly elevated in children with confirmed AHT compared with those with suspected AHT and those with other types of TBI. OPN expression may help identify children with suspected AHT to aid resource stratification and triage of appropriate interventions for children who are potential victims of abuse.