Biomarkers for Traumatic Brain Injury Proceedings of a Workshop (2023) / Chapter Skim
Currently Skimming:
2 How Biomarkers for Traumatic Brain Injury Can Contribute to Care and Research
2 How Biomarkers for Traumatic Brain Injury Can Contribute to Care and Research
Pages 7-18
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 7... ...
It is difficult to generalize biomarker findings to TBI in this population. To address the needs of older adults, a patient-centered approach is needed that focuses on the clini cal care junctures in which enhanced use of TBI biomarkers would be most valuable (Lazarus)
|
From page 8... ...
Thus, said Stuart Hoffman, Department of Veterans Affairs, the field needs to continue to understand how different types of biomarkers and biomarker devices can address different needs, as well as how to integrate the information provided by multiple biomarkers. ORIENTATION TO TBI BIOMARKERS1 Ramon Diaz-Arrastia, University of Pennsylvania, provided an orientation to four of the settings along the care continuum in which biomarkers for TBI could be used: prehospital settings, emergency departments, hospital intensive care units, and rehabilitation and chronic care locations.
|
From page 9... ...
for further care, or whether they can safely be sent home. Additionally, prehospital use of biomarkers could inform the decision of whether the patient may be transferred to the nearest emergency department, which may be at a community hospital, or needs to be transferred to a Level 1 trauma center where advanced neurosurgical care is available.2 Biomarkers to inform this decision need to have high sensitivity (ability to identify that a TBI has occurred)
|
From page 10... ...
In hospital intensive care units (ICUs) , Diaz-Arrastia explained that biomarkers can be useful for identifying patients at risk of secondary brain injury, such as ischemia, intracranial hypertension, and inflammation, as well as helping to select patients for clinical trials of neuroprotective or neurorestorative therapies.
|
From page 11... ...
Challenges and Opportunities in Geriatric Traumatic Brain Injury4 Adults aged 65 and older have the highest rates of TBI-related hospitalizations and deaths, experience higher morbidity and mortality from TBI, and have slower recovery trajectories than younger patients, noted Rachel Lazarus, a neuroscientist at AARP. For addressing the needs of older adults, she called for a patient-centered approach that focuses on critical junctures in clinical care in which enhanced use of TBI biomarkers would be most valuable.
|
From page 12... ...
Biomarker candidates such as S100B, GFAP, and Tau have shown lower specificity in older patients to discriminate among those who have mild TBI with and without CT evidence of intercranial trauma. It is not clear whether the observed differences are caused by differences in injury mechanism, age-related changes in baseline expression of protein biomarkers, age-related changes in biomarker expression after injury, or other factors.
|
From page 13... ...
6 would be an excellent platform for studying how TBI biomarkers can assist prehospital providers in making the most appropriate transport decisions, he said. In the ED, Bazarian identified two unmet needs.
|
From page 14... ...
The cardiac care field has also experienced changes in specified troponin cutoff concentrations over time, he said, from cutoff values that allowed diagnosis of MI to cutoff values that now enable detection of minor myocardial injury. How to set TBI biomarker cutoff concentrations and interpret test results, accounting for biological variation that results in a range of values across populations, will be critical questions.
|
From page 15... ...
Bazarian commented that FDA-cleared biomarker assays can provide additional meaning and value to the evaluation of TBI patients in the emergency department, but that doctors do not want to miss a serious intracranial injury and typically overscan. In the absence of recognized clinical practice guidelines or hospital policies, physicians may
|
From page 16... ...
be reluctant to rely on a blood biomarker test without a scan to back it up if there is a possibility the injury could be serious. Diaz-Arrastia added that one reason head CTs are ordered in the ED is to identify acute epidural hematoma.
|
From page 17... ...
They are less comfortable relying on new biomarkers to provide sensitivity -- as in deciding whether or not to order a CT scan. Wu also saw little chance of eliminating head CT scans because it is the standard approach and because neuroimaging is needed to evaluate certain injuries, but he said that a move beyond the use of biomarkers to rule in or rule out a head CT and toward their use for more accurate TBI diagnosis will be a key focus, including the possibility of taking serial blood biomarker measurements to identify change over time.
|
From page 18... ...
18 BIOMARKERS FOR TRAUMATIC BRAIN INJURY diagnosis and risk stratification, as well as ultimately to guide therapy. Biomarkers are needed to capture the different endophenotypes exhibited by TBI patients.8 In the future, he said, the goal is to be able to order a panel of TBI biomarkers that provide information on such elements as axonal injury, inflammation, and vascular damage.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.