Could a blood test detect infant abusive head traumas?
Researchers from the Children’s Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine (PA, USA) have developed a serum-based test that could specifically detect acute intracranial haemorrhage with their findings published in JAMA Pediatrics. The blood test could reduce misdiagnosis by measuring a combination of three biomarkers and the level of hemoglobin.
It is important that abusive head trauma (AHT) is rapidly diagnosed as misdiagnosis could lead to permanent brain damage or death. Senior author Rachel Berger (University of Pittsburgh School of Medicine) commented: “Abusive head trauma is the leading cause of death from traumatic brain injury in infants and the leading cause of death from physical abuse in the United States.”
The team collaborated with Axela (a Canadian molecular diagnostics company) and developed the test which simultaneously detects multiple biomarkers, called the Biomarkers for Infant Brain Injury Score (BIBIS). By testing 599 infants who were enrolled at three study sites, the predictive capacity of the BIBIS was evaluated.
The test was demonstrated to correctly detect intracranial haemorrhage approximately 90% of the time compared to clinical judgement which is approximately 70%. However, the specificity of the test was 48% – this is the ability to correctly identify an infant without bleeding who would not require further evaluation.
“The test is not intended to replace clinical judgement, which is crucial,” stated Berger. “Rather, we believe that it can supplement clinical evaluation and in cases where symptoms may be unclear, help physicians make a decision about whether an infant needs brain imaging.”
The test was aimed to be highly sensitive rather than accurate as missing a diagnosis has more serious consequences than brain imaging infants without the condition. In the future, before the test could be used clinically it would need to be validated in a larger group and receive regulatory approval.
Sources: Berger R.P, Pak B.J, Kolesnikova M.D et al. Derivation and validation of a serum biomarker panel to identify infants with acute intracranial hemorrhage JAMA Pediatr. doi:10.1001/jamapediatrics.2017.0429 (2017); www.upmc.com/media/NewsReleases/2017/Pages/head-trauma.aspx
