D-dimers to detect traumatic brain injury

Abstract

Is there a biomarker to help identify children at risk for traumatic brain injury, particularly mild abusive head trauma, who might then benefit from additional screening with head computed tomography (CT)? Berger et al examine serum d-dimer concentration first retrospectively among a discovery cohort of children less than age 4 years, assessing 93 controls without traumatic brain injury and 102 cases with traumatic brain injury suspected to be abuse. Significantly higher levels were seen in the cases, who had a median level of 0.43 μg/L. Then prospectively among a validation cohort of 24 prospective normal controls and 20 cases with abnormal head CT demonstrating brain injury, and using a cutoff of 0.59 μg/L, the sensitivity and specificity for identification of a cases by d-dimer concentration was 90% and 75%, respectively. At a cutoff of 1.0 μg/L positive predictive value and negative predictive values were 87% and 88%, respectively. Serum d-dimer level might identify children who would benefit from neuroimaging to evaluate for possibility of brain injury. Additional study will be needed to delineate better the validity and utility of this and other markers. Article page 383▶ Serum D-Dimer Concentrations Are Increased after Pediatric Traumatic Brain InjuryThe Journal of PediatricsVol. 166Issue 2PreviewTo determine whether D-dimer would be increased in children with traumatic brain injury (TBI), specifically mild abusive head trauma. Full-Text PDF