A new study suggests that closer focus on levels of the protein tau in children with traumatic brain injury (TBI) could improve diagnosis, giving a clearer picture of the individual’s outlook.

Tau has long been associated with traumatic brain injury, with studieslinking it to both acute symptoms and long-term complications. It is also known to have a role in the onset of Alzheimer’s and Parkinson’s.

A new study has provided further evidence that levels of tauincrease in children with brain injuries and could be used to gauge their severity.

It could also reduce the need for CT scans, amid some concerns about the potential impact of radiation and sedation on young children.

Australian charity the Murdoch Children’s Research Institute (MCRI), worked with Canadian scientists to analyse blood from 158 children who presented with head injuries at children’s hospitals in Melbourne, Toronto, Montreal and Vancouver from 2011 to 2013.

These patients were selected from a pool of 1680 children who presented with head injuries. Their results were compared with those of 416 healthy children.

The study aimed to assess whether levels of the blood biomarker tau could help clinicians to better understand the severity of brain injury in people under 18. 

It is believed to be the first large-scale study into tau concentrations in both healthy children and children with traumatic brain injury.

MCRI’s clinical services director Professor Vicki Anderson says: “CT scans are used to diagnose brain injury but there are concerns about exposing children to radiation and young children often need to be sedated.

“Doctors can measure levels of the neuronal microtubule-associated protein tau and this indicates the severity of brain injury in adults. However tau levels naturally fluctuate more in children so research was needed to test whether this would work.”

The study found that measuring levels of tau in older children gives doctors an indication of the severity of mild brain disorders, however more research is needed.

Anderson says: “Measuring tau levels will help us identify which children with brain injury will recover well and which will have the highest risk of ongoing problems and so require treatment, such as rehabilitation and ongoing support at school.

“Tau levels naturally fall in healthy children as they age but tau increases immediately after a traumatic brain injury.” 

To use blood samples to assess the severity of child brain injuries, researchers first established what the normal levels of tau in children should be according to age.

They showed that tau decreases as children grow, with three significant age partitions, less than four years, four to 15 years and 16 to 19 years.

Future studies are needed to look at tau levels after the first day of injury and also to search for other biomarkers of brain injury.

According to the MCRI, TBI is the leading cause of death and acquired disability for children in high-income countries like Australia and Canada. 

“Around 0.7 per cent of the child population is treated in emergency departments every year for traumatic brain injury, that’s almost one in a hundred children,” Anderson says.

“The leading causes of traumatic brain injury to children are falls, car crashes, sport and abuse.”

Prof Anderson is heading to the UK later this year, as akeynote speaker at The Children’s Trust’s national paediatric brain injury conference. The event, entitledBuilding the Future of Childhood Brain Injury, takes place in London on 6 September at the Royal Society of Medicine in London.

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