Pediatric traumatic brain injury: the utility of beta-natriuretic peptide.

BACKGROUND: According to the literature, serum beta-natriuretic peptide (BNP) levels have been shown to increase in adult trauma patients, specifically for those with traumatic brain injury and in those with intracranial hemorrhage. It has been suggested that BNP levels may be an ideal serum marker for traumatic brain injury. It may save time and radiation if the levels correlated with head computed tomography (CT) scan findings, especially for pediatric patients who have higher radiation risks. We hypothesized that serum BNP levels would be elevated in patients with intracranial bleeding on head CT.
METHOD: Serum BNP levels were drawn from 95 consecutive "Level I status" pediatric trauma patients immediately on presentation to the emergency department. These patients had high impact mechanisms, were altered, or were physiologically unstable. The findings of head CTs were recorded. Patients were subsequently divided into a negative bleed or positive bleed group. Clinical data such as Glasgow Coma Scale, loss of consciousness, and hospital course were collected. Results were compared using Wilcoxon rank sum test and Spearman correlation coefficients.
RESULTS: BNP levels did not increase significantly in the positive bleed group (n = 21) compared with the negative bleed group (n = 74) (p = 0.48). BNP levels did not correlate with loss of consciousness, Glasgow Coma Scale, Injury Severity Score, or hospital stay.
CONCLUSION: BNP levels drawn at the time of the emergency department visit do not seem to be a predictor for intracranial hemorrhage in pediatric trauma patients. A head CT still remains the best diagnostic study for diagnosing intracranial hemorrhage.