Blood-Based Protein Biomarkers for the Management of Traumatic Brain Injuries in Adults
Presenting with Mild Head Injury to Emergency Departments : A Living Systematic Review
and Meta-Analysis
Accurate diagnosis of traumatic brain injury (TBI) is critical to effective management
and intervention, but can be challenging in patients with mild TBI. A substantial
number of studies have reported the use of circulating biomarkers as signatures for
TBI, capable of improving diagnostic accuracy and clinical decision-making beyond
current practice standards. We performed a systematic review and meta-analysis to
comprehensively and critically evaluate the existing body of evidence for the use
of blood protein biomarkers (S100B, GFAP, NSE, UCH-L1, Tau and Neurofilament proteins)
for diagnosis of intracranial lesions on CT following mild TBI. Effects of potential
confounding factors and differential diagnostic performance of the included markers
were explored. Furthermore, appropriateness of study design, analysis, quality and
demonstration of clinical utility were assessed. Studies published up to October 2016
were identified through a MEDLINE, EMBASE and CINHAL search. Following screening of
the identified articles, 26 were selected as relevant. We found that measurement of
S100B can help informed decision making in the emergency department possibly reducing
resource use, but there is insufficient evidence that any of the other markers is
ready for clinical application. Our work pointed out serious problems in the design,
analysis and reporting of many of the studies and identi fi ed a substantial heterogeneity
and research gaps. These findings emphasize the importance of methodologically rigorous
studies focused on a biomarker's intended use and defining standardized, validated
and reproducible approaches. The living nature of this systematic review, which will
summarize key updated information as it becomes available, can inform and guide future
implementation of biomarkers in the clinical arena.