Skip to main content

Advertisement

SpringerLink
Log in

Clinical applications of biomarkers in pediatric traumatic brain injury

  • Focus Session
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

The diagnosis, treatment, and prediction of outcome in pediatric traumatic brain injury (TBI) present significant challenges to the treating clinician. Clinical and radiological tools for assessing injury severity and predicting outcome, in particular, lack sensitivity and specificity. In patients with mild TBI, often there is uncertainty about which patients should undergo radiological imaging and who is at risk for long term neurological sequelae. In severe TBI, often there is uncertainty about which patients will experience secondary insults and what the outcome for individual patients will be. In several other clinical specialties, biomarkers are used to diagnose disease, direct treatment, and prognosticate. However, an ideal biomarker for brain injury has not been found.

Methods

In this review, we examine the various factors that must be taken into account in the search for a reliable biomarker in brain injury. We review the important studies that have investigated common biomarkers of structural brain injury, in particular S100B, neuron-specific enolase, myelin basic protein, and glial fibrillary acid protein.

Discussion

The potential uses and limitations of these biomarkers in the context of TBI are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW, American Association for Surgery of Trauma, Child Neurology Society, International Society for Pediatric Neurosurgery, International Trauma Anesthesia and Critical Care Society, Society of Critical Care Medicine, World Federation of Pediatric Intensive and Critical Care Societies (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 5. Indications for intracranial pressure monitoring in pediatric patients with severe traumatic brain injury. Pediatr Crit Care Med 4(3 Suppl):S19–S24

    PubMed  Google Scholar 

  2. Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW, American Association for Surgery of Trauma, Child Neurology Society, International Society for Pediatric Neurosurgery, International Trauma Anesthesia and Critical Care Society, Society of Critical Care Medicine, World Federation of Pediatric Intensive and Critical Care Societies (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 8. Cerebral perfusion pressure. Pediatr Crit Care Med 4(3 Suppl):S31–S33

    PubMed  Google Scholar 

  3. Adelson PD, Nemoto E, Colak A, Painter M (1998) The use of near infrared spectroscopy (NIRS) in children after traumatic brain injury: a preliminary report. Acta Neurochir Suppl 71:250–254

    CAS  PubMed  Google Scholar 

  4. Anderson RE, Hansson LO, Nilsson O, Dijlai-Merzoug R, Settergren G (2001) High serum S100B levels for trauma patients without head injuries. Neurosurgery 48(6):1255–1258 discussion 1258–1260

    Article  CAS  PubMed  Google Scholar 

  5. Bakay RA, Ward AA Jr (1983) Enzymatic changes in serum and cerebrospinal fluid in neurological injury. J Neurosurg 58(1):27–37

    Article  CAS  PubMed  Google Scholar 

  6. Bandyopadhyay S, Hennes H, Gorelick MH, Wells RG, Walsh-Kelly CM (2005) Serum neuron-specific enolase as a predictor of short-term outcome in children with closed traumatic brain injury. Acad Emerg Med 12(8):732–738

    Article  PubMed  Google Scholar 

  7. Beers SR, Berger RP, Adelson PD (2007) Neurocognitive outcome and serum biomarkers in inflicted versus non-inflicted traumatic brain injury in young children. J Neurotrauma 24(1):97–105

    Article  PubMed  Google Scholar 

  8. Berger RP (2006) The use of serum biomarkers to predict outcome after traumatic brain injury in adults and children. J Head Trauma Rehabil 21(4):315–333

    Article  PubMed  Google Scholar 

  9. Berger RP, Adelson PD, Pierce MC, Dulani T, Cassidy LD, Kochanek PM (2005) Serum neuron-specific enolase, S100B, and myelin basic protein concentrations after inflicted and noninflicted traumatic brain injury in children. J Neurosurg 103(1 Suppl):61–68

    PubMed  Google Scholar 

  10. Berger RP, Beers SR, Richichi R, Wiesman D, Adelson PD (2007) Serum biomarker concentrations and outcome after pediatric traumatic brain injury. J Neurotrauma 24(12):1793–1801

    Article  PubMed  Google Scholar 

  11. Berger RP, Kochanek PM (2006) Urinary S100B concentrations are increased after brain injury in children: a preliminary study. Pediatr Crit Care Med 7(6):557–561

    Article  PubMed  Google Scholar 

  12. Berger RP, Pierce MC, Wisniewski SR, Adelson PD, Clark RS, Ruppel RA, Kochanek PM (2002) Neuron-specific enolase and S100B in cerebrospinal fluid after severe traumatic brain injury in infants and children. Pediatrics 109(2):E31

    Article  PubMed  Google Scholar 

  13. Berger RP, Ta'asan S, Rand A, Lokshin A, Kochanek P (2008) Multiplex assessment of serum biomarker concentrations in well-appearing children with inflicted traumatic brain injury. Pediatr Res 65:97–102

    Article  Google Scholar 

  14. Castellani C, Stojakovic T, Cichocki M, Scharnagl H, Erwa W, Gutmann A, Weinberg AM (2008) Reference ranges for neuroprotein S-100B: from infants to adolescents. Clin Chem Lab Med 46(9):1296–1299

    Article  CAS  PubMed  Google Scholar 

  15. Figaji AA, Fieggen AG, Argent AC, Leroux PD, Peter JC (2008) Does adherence to treatment targets in children with severe traumatic brain injury avoid brain hypoxia? A brain tissue oxygenation study. Neurosurgery 63(1):83–91 discussion 91–92

    Article  PubMed  Google Scholar 

  16. Figaji AA, Zwane E, Fieggen AG, Peter JC, LeRoux PD (2008) Acute clinical grading in pediatric severe traumatic brain injury and its association with subsequent intracranial pressure, cerebral perfusion pressure, and brain oxygenation. Neurosurg Focus 25(4):E4

    Article  PubMed  Google Scholar 

  17. Gazzolo D, Abella R, Marinoni E, Di Iorio R, Volti GL, Galvano F, Pongiglione G, Frigiola A, Bertino E, Florio P (2009) Circulating biochemical markers of brain damage in infants complicated by ischemia reperfusion injury. Cardiovasc Hematol Agents Med Chem 7(2):108–126

    Article  CAS  PubMed  Google Scholar 

  18. Gazzolo D, Bruschettini M, Lituania M, Serra G, Bonacci W, Michetti F (2001) Increased urinary S100B protein as an early indicator of intraventricular hemorrhage in preterm infants: correlation with the grade of hemorrhage. Clin Chem 47(10):1836–1838

    CAS  PubMed  Google Scholar 

  19. Gazzolo D, Florio P, Ciotti S, Marinoni E, di Iorio R, Bruschettini M, Sacchi R, Serra G, Lituania M, Michetti F (2005) S100B protein in urine of preterm newborns with ominous outcome. Pediatr Res 58(6):1170–1174

    Article  CAS  PubMed  Google Scholar 

  20. Gazzolo D, Grutzfeld D, Michetti F, Toesca A, Lituania M, Bruschettini M, Dobrzanska A, Bruschettini P (2004) Increased S100B in cerebrospinal fluid of infants with bacterial meningitis: relationship to brain damage and routine cerebrospinal fluid findings. Clin Chem 50(5):941–944

    Article  CAS  PubMed  Google Scholar 

  21. Gazzolo D, Marinoni E, Di Iorio R, Bruschettini M, Kornacka M, Lituania M, Majewska U, Serra G, Michetti F (2004) Urinary S100B protein measurements: a tool for the early identification of hypoxic-ischemic encephalopathy in asphyxiated full-term infants. Crit Care Med 32(1):131–136

    Article  CAS  PubMed  Google Scholar 

  22. Gazzolo D, Michetti F, Bruschettini M, Marchese N, Lituania M, Mangraviti S, Pedrazzi E, Bruschettini P (2003) Pediatric concentrations of S100B protein in blood: age- and sex-related changes. Clin Chem 49(6 Pt 1):967–970

    Article  CAS  PubMed  Google Scholar 

  23. Giza CC, Mink RB, Madikians A (2007) Pediatric traumatic brain injury: not just little adults. Curr Opin Crit Care 13(2):143–152

    Article  PubMed  Google Scholar 

  24. Goncalves CA, Leite MC, Nardin P (2008) Biological and methodological features of the measurement of S100B, a putative marker of brain injury. Clin Biochem 41(10–11):755–763

    Article  CAS  PubMed  Google Scholar 

  25. Guzel A, Er U, Tatli M, Aluclu U, Ozkan U, Duzenli Y, Satici O, Guzel E, Kemaloglu S, Ceviz A, Kaplan A (2008) Serum neuron-specific enolase as a predictor of short-term outcome and its correlation with Glasgow coma scale in traumatic brain injury. Neurosurg Rev 31(4):439–444 discussion 444–445

    Article  PubMed  Google Scholar 

  26. Haimoto H, Hosoda S, Kato K (1987) Differential distribution of immunoreactive S100-alpha and S100-beta proteins in normal nonnervous human tissues. Lab Invest 57(5):489–498

    CAS  PubMed  Google Scholar 

  27. Harpio R, Einarsson R (2004) S100 proteins as cancer biomarkers with focus on S100B in malignant melanoma. Clin Biochem 37(7):512–518

    Article  CAS  PubMed  Google Scholar 

  28. Hergenroeder G, Redell JB, Moore AN, Dubinsky WP, Funk RT, Crommett J, Clifton GL, Levine R, Valadka A, Dash PK (2008) Identification of serum biomarkers in brain-injured adults: potential for predicting elevated intracranial pressure. J Neurotrauma 25(2):79–93

    Article  PubMed  Google Scholar 

  29. Hillered L, Vespa PM, Hovda DA (2005) Translational neurochemical research in acute human brain injury: the current status and potential future for cerebral microdialysis. J Neurotrauma 22(1):3–41

    Article  PubMed  Google Scholar 

  30. Ingebrigtsen T, Romner B (2003) Biochemical serum markers for brain damage: a short review with emphasis on clinical utility in mild head injury. Restor Neurol Neurosci 21(3–4):171–176

    CAS  PubMed  Google Scholar 

  31. Ingebrigtsen T, Waterloo K, Jacobsen EA, Langbakk B, Romner B (1999) Traumatic brain damage in minor head injury: relation of serum S-100 protein measurements to magnetic resonance imaging and neurobehavioral outcome. Neurosurgery 45(3):468–475 discussion 475–476

    Article  CAS  PubMed  Google Scholar 

  32. Jackson RG, Samra GS, Radcliffe J, Clark GH, Price CP (2000) The early fall in levels of S-100 beta in traumatic brain injury. Clin Chem Lab Med 38(11):1165–1167

    Article  CAS  PubMed  Google Scholar 

  33. Kato K, Kimura S (1985) S100ao (alpha alpha) protein is mainly located in the heart and striated muscles. Biochim Biophys Acta 842(2–3):146–150

    CAS  PubMed  Google Scholar 

  34. Kirino T, Brightman MW, Oertel WH, Schmechel DE, Marangos PJ (1983) Neuron-specific enolase as an index of neuronal regeneration and reinnervation. J Neurosci 3(5):915–923

    CAS  PubMed  Google Scholar 

  35. Kleindienst A, Tolias CM, Corwin FD, Muller C, Marmarou A, Fatouros P, Bullock MR (2005) Assessment of cerebral S100B levels by proton magnetic resonance spectroscopy after lateral fluid-percussion injury in the rat. J Neurosurg 102(6):1115–1121

    Article  CAS  PubMed  Google Scholar 

  36. Kochanek PM, Berger RP, Bayir H, Wagner AK, Jenkins LW, Clark RS (2008) Biomarkers of primary and evolving damage in traumatic and ischemic brain injury: diagnosis, prognosis, probing mechanisms, and therapeutic decision making. Curr Opin Crit Care 14(2):135–141

    Article  PubMed  Google Scholar 

  37. Liu MC, Akle V, Zheng W, Kitlen J, O'Steen B, Larner SF, Dave JR, Tortella FC, Hayes RL, Wang KK (2006) Extensive degradation of myelin basic protein isoforms by calpain following traumatic brain injury. J Neurochem 98(3):700–712

    Article  CAS  PubMed  Google Scholar 

  38. Lo TY, Jones PA, Minns RA (2009) Pediatric brain trauma outcome prediction using paired serum levels of inflammatory mediators and brain specific proteins. J Neurotrauma 26(9):1479–1487

    Article  PubMed  Google Scholar 

  39. Lomas JP, Dunning J (2005) Best evidence topic report. S-100b protein levels as a predictor for long-term disability after head injury. Emerg Med J 22(12):889–891

    Article  PubMed  Google Scholar 

  40. Lumpkins KM, Bochicchio GV, Keledjian K, Simard JM, McCunn M, Scalea T (2008) Glial fibrillary acidic protein is highly correlated with brain injury. J Trauma 65(4):778–782 discussion 782–784

    Article  CAS  PubMed  Google Scholar 

  41. Marenholz I, Heizmann CW, Fritz G (2004) S100 proteins in mouse and man: from evolution to function and pathology (including an update of the nomenclature). Biochem Biophys Res Commun 322(4):1111–1122

    Article  CAS  PubMed  Google Scholar 

  42. Mazzini GS, Souza DO, Portela LV (2009) The ischemic heart as an extracerebral source for S100B. Resuscitation 80(1):144

    Article  PubMed  Google Scholar 

  43. Meybohm P, Cavus E, Dorges V, Weber B, Stadlbauer KH, Wenzel V, Scholz J, Steffen M, Bein B (2008) Release of protein S100B in haemorrhagic shock: effects of small volume resuscitation combined with arginine vasopressin. Resuscitation 76(3):449–456

    Article  CAS  PubMed  Google Scholar 

  44. Moore BW (1965) A soluble protein characteristic of the nervous system. Biochem Biophys Res Commun 19(6):739–744

    Article  CAS  PubMed  Google Scholar 

  45. Muller K, Townend W, Biasca N, Unden J, Waterloo K, Romner B, Ingebrigtsen T (2007) S100B serum level predicts computed tomography findings after minor head injury. J Trauma 62(6):1452–1456

    Article  CAS  PubMed  Google Scholar 

  46. Nylen K, Ost M, Csajbok LZ, Nilsson I, Blennow K, Nellgard B, Rosengren L (2006) Increased serum-GFAP in patients with severe traumatic brain injury is related to outcome. J Neurol Sci 240(1–2):85–91

    Article  CAS  PubMed  Google Scholar 

  47. Park ES, Park CI, Baek SY, Kim SW, Baek SK, Kim HO (2000) Serum immunoreactivity to S-100 in children with cerebral palsy and delayed development and in their healthy parents. Yonsei Med J 41(3):328–332

    CAS  PubMed  Google Scholar 

  48. Pelinka LE, Harada N, Szalay L, Jafarmadar M, Redl H, Bahrami S (2004) Release of S100B differs during ischemia and reperfusion of the liver, the gut, and the kidney in rats. Shock 21(1):72–76

    Article  CAS  PubMed  Google Scholar 

  49. Pelinka LE, Hertz H, Mauritz W, Harada N, Jafarmadar M, Albrecht M, Redl H, Bahrami S (2005) Nonspecific increase of systemic neuron-specific enolase after trauma: clinical and experimental findings. Shock 24(2):119–123

    Article  CAS  PubMed  Google Scholar 

  50. Pelinka LE, Jafarmadar M, Redl H, Bahrami S (2004) Neuron-specific-enolase is increased in plasma after hemorrhagic shock and after bilateral femur fracture without traumatic brain injury in the rat. Shock 22(1):88–91

    Article  CAS  PubMed  Google Scholar 

  51. Pelinka LE, Kroepfl A, Leixnering M, Buchinger W, Raabe A, Redl H (2004) GFAP versus S100B in serum after traumatic brain injury: relationship to brain damage and outcome. J Neurotrauma 21(11):1553–1561

    Article  PubMed  Google Scholar 

  52. Pelinka LE, Kroepfl A, Schmidhammer R, Krenn M, Buchinger W, Redl H, Raabe A (2004) Glial fibrillary acidic protein in serum after traumatic brain injury and multiple trauma. J Trauma 57(5):1006–1012

    Article  CAS  PubMed  Google Scholar 

  53. Pelinka LE, Szalay L, Jafarmadar M, Schmidhammer R, Redl H, Bahrami S (2003) Circulating S100B is increased after bilateral femur fracture without brain injury in the rat. Br J Anaesth 91(4):595–597

    Article  CAS  PubMed  Google Scholar 

  54. Piazza O, Storti MP, Cotena S, Stoppa F, Perrotta D, Esposito G, Pirozzi N, Tufano R (2007) S100B is not a reliable prognostic index in paediatric TBI. Pediatr Neurosurg 43(4):258–264

    Article  CAS  PubMed  Google Scholar 

  55. Pickering A, Carter J, Hanning I, Townend W (2008) Emergency department measurement of urinary S100B in children following head injury: can extracranial injury confound findings? Emerg Med J 25(2):88–89

    Article  CAS  PubMed  Google Scholar 

  56. Portela LV, Tort AB, Schaf DV, Ribeiro L, Nora DB, Walz R, Rotta LN, Silva CT, Busnello JV, Kapczinski F, Goncalves CA, Souza DO (2002) The serum S100B concentration is age dependent. Clin Chem 48(6 Pt 1):950–952

    CAS  PubMed  Google Scholar 

  57. Raabe A, Grolms C, Keller M, Dohnert J, Sorge O, Seifert V (1998) Correlation of computed tomography findings and serum brain damage markers following severe head injury. Acta Neurochir (Wien) 140(8):787–791 discussion 791–792

    Article  CAS  Google Scholar 

  58. Raabe A, Grolms C, Sorge O, Zimmermann M, Seifert V (1999) Serum S-100B protein in severe head injury. Neurosurgery 45(3):477–483

    Article  CAS  PubMed  Google Scholar 

  59. Raabe A, Seifert V (1999) Fatal secondary increase in serum S-100B protein after severe head injury report of three cases. J Neurosurg 91(5):875–877

    Article  CAS  PubMed  Google Scholar 

  60. Raabe A, Seifert V (2000) Protein S-100B as a serum marker of brain damage in severe head injury: preliminary results. Neurosurg Rev 23(3):136–138

    Article  CAS  PubMed  Google Scholar 

  61. Ramont L, Thoannes H, Volondat A, Chastang F, Millet MC, Maquart FX (2005) Effects of hemolysis and storage condition on neuron-specific enolase (NSE) in cerebrospinal fluid and serum: implications in clinical practice. Clin Chem Lab Med 43(11):1215–1217

    Article  CAS  PubMed  Google Scholar 

  62. Romner B, Ingebrigtsen T, Kongstad P, Borgesen SE (2000) Traumatic brain damage: serum S-100 protein measurements related to neuroradiological findings. J Neurotrauma 17(8):641–647

    Article  CAS  PubMed  Google Scholar 

  63. Rothermundt M, Peters M, Prehn JH, Arolt V (2003) S100B in brain damage and neurodegeneration. Microsc Res Tech 60(6):614–632

    Article  CAS  PubMed  Google Scholar 

  64. Routsi C, Stamataki E, Nanas S, Psachoulia C, Stathopoulos A, Koroneos A, Zervou M, Jullien G, Roussos C (2006) Increased levels of serum S100B protein in critically ill patients without brain injury. Shock 26(1):20–24

    Article  CAS  PubMed  Google Scholar 

  65. Sedaghat F, Notopoulos A (2008) S100 protein family and its application in clinical practice. Hippokratia 12(4):198–204

    CAS  PubMed  Google Scholar 

  66. Shore PM, Berger RP, Varma S, Janesko KL, Wisniewski SR, Clark RS, Adelson PD, Thomas NJ, Lai YC, Bayir H, Kochanek PM (2007) Cerebrospinal fluid biomarkers versus glasgow coma scale and glasgow outcome scale in pediatric traumatic brain injury: the role of young age and inflicted injury. J Neurotrauma 24(1):75–86

    Article  PubMed  Google Scholar 

  67. Spinella PC, Dominguez T, Drott HR, Huh J, McCormick L, Rajendra A, Argon J, McIntosh T, Helfaer M (2003) S-100beta protein-serum levels in healthy children and its association with outcome in pediatric traumatic brain injury. Crit Care Med 31(3):939–945

    Article  CAS  PubMed  Google Scholar 

  68. Spinella PC, Donoghue A, Rajendra A, Drott HR, Dominguez TE, Helfaer M (2004) Cerebrospinal fluid levels of S-100beta in children and its elevation in pediatric meningitis. Pediatr Crit Care Med 5(1):53–57

    Article  PubMed  Google Scholar 

  69. Steiner J, Bernstein HG, Bielau H, Berndt A, Brisch R, Mawrin C, Keilhoff G, Bogerts B (2007) Evidence for a wide extra-astrocytic distribution of S100B in human brain. BMC Neurosci 8:2

    Article  PubMed  Google Scholar 

  70. Stiefel MF, Udoetuk JD, Spiotta AM, Gracias VH, Goldberg A, Maloney-Wilensky E, Bloom S, Le Roux PD (2006) Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg 105(4):568–575

    Article  PubMed  Google Scholar 

  71. Subbaswamy A, Hsu AA, Weinstein S, Bell MJ (2009) Correlation of cerebral near-infrared spectroscopy (cNIRS) and neurological markers in critically ill children. Neurocrit Care 10(1):129–135

    Article  CAS  PubMed  Google Scholar 

  72. Townend W, Ingebrigtsen T (2006) Head injury outcome prediction: a role for protein S-100B? Injury 37(12):1098–1108

    Article  PubMed  Google Scholar 

  73. Unden J, Bellner J, Astrand R, Romner B (2005) Serum S100B levels in patients with epidural haematomas. Br J Neurosurg 19(1):43–45

    Article  CAS  PubMed  Google Scholar 

  74. Unden J, Romner B (2009) A new objective method for CT triage after minor head injury—serum S100B. Scand J Clin Lab Invest 69(1):13–17

    Article  CAS  PubMed  Google Scholar 

  75. Van Eldik LJ, Wainwright MS (2003) The janus face of glial-derived S100B: beneficial and detrimental functions in the brain. Restor Neurol Neurosci 21(3–4):97–108

    PubMed  Google Scholar 

  76. Wiesmann M, Missler U, Gottmann D, Gehring S (1998) Plasma S-100b protein concentration in healthy adults is age- and sex-independent. Clin Chem 44(5):1056–1058

    CAS  PubMed  Google Scholar 

  77. Woertgen C, Rothoerl RD, Metz C, Brawanski A (1999) Comparison of clinical, radiologic, and serum marker as prognostic factors after severe head injury. J Trauma 47(6):1126–1130

    Article  CAS  PubMed  Google Scholar 

  78. Wright NT, Inman KG, Levine JA, Cannon BR, Varney KM, Weber DJ (2008) Refinement of the solution structure and dynamic properties of ca(2+)-bound rat S100B. J Biomol NMR 42(4):279–286

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported in part by a grant from the South African-Swedish Links Program (GUN 2072790).

Author information

Authors and Affiliations

  1. Division of Neurosurgery, School of Child and Adolescent Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa

    Simon J. I. Sandler & Anthony A. Figaji

  2. Phoenix Children’s Neuroscience Institute, 1919 E Thomas Rd, Phoenix, AZ, USA

    P. David Adelson

  3. Red Cross Children’s Hospital, 617 ICH building, Klipfontein road, Rondebosch, 7700, Cape Town, South Africa

    Anthony A. Figaji

Authors
  1. Simon J. I. Sandler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony A. Figaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. David Adelson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony A. Figaji.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sandler, S.J.I., Figaji, A.A. & Adelson, P.D. Clinical applications of biomarkers in pediatric traumatic brain injury. Childs Nerv Syst 26, 205–213 (2010). https://doi.org/10.1007/s00381-009-1009-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-009-1009-1

Keywords

Search

Navigation