Fluid Biomarkers of Pediatric Mild Traumatic Brain Injury: A Systematic Review.

Public concern is growing about the short- and long-term effects of pediatric mild traumatic brain injury (mTBI). This concern is amplified because pediatric mTBI has the potential to go undiagnosed in acute care settings, placing children at increased risk for reinjury prior to complete recovery. The management of mTBI can be particularly challenging due to the lack of validated biomarkers that clinicians can use to objectively diagnose pediatric mTBI, predict risk for prolonged recovery, or demonstrate mTBI recovery. Fluid-based biomarkers have drawn increased attention as an objective measure to diagnose and manage pediatric mTBI, but investigations of promising biomarkers may pose unique challenges in pediatric populations. Our systematic review confirms the relative paucity of high-quality, clinically impactful diagnostic or prognostic fluid biomarker studies, on samples representing only a small fraction of pediatric mTBI. Ultimately, well-designed longitudinal studies across diverse points of care are needed to truly characterize the utility of fluid biomarkers of injury and recovery for the pediatric mTBI patient.