• Article
  • August 1, 2017

Blood Test Helps Identify Abusive Head Trauma in Infants

A new blood test could help clinicians identify shaken baby syndrome.

Researchers at Children's Hospital of Pittsburgh of UPMC have developed a blood test that could help clinicians identify infants who may have had bleeding of the brain as a result of abusive head trauma (AHT), sometimes referred to as shaken baby syndrome.

The serum-based test, which needs to be validated in a larger population and receive regulatory approval before being used in clinical practice, would be the first of its kind to detect bleeding of the brain. Infants who test positive would then have further evaluation via brain imaging to determine the source of the bleeding.

AHT 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. But about 30 percent of AHT diagnoses are missed when caretakers provide inaccurate histories or when infants have nonspecific symptoms such as vomiting or fussiness. Missed diagnoses can be catastrophic because AHT can lead to permanent brain damage and even death.

How it works

Researchers at UPMC collaborated with a molecular diagnostics company to develop a test that could reduce the chances of a missed diagnosis. The test uses a combination of three biomarkers, along with a measure of the patient's level of hemoglobin, the protein that carries oxygen in blood. An automated testing system allowed the researchers to measure multiple biomarkers simultaneously using an extremely small amount of blood.

To arrive at the formula for discriminating between infants with and without intracranial hemorrhage, called the Biomarkers for Infant Brain Injury Score (BIBIS), the team used previously stored serum samples from a databank.

Supplementing clinical evaluation

Researchers then evaluated the predictive capacity of the BIBIS value in a second population of 599 infants enrolled at three study sites. In addition to UPMC, infants were enrolled at Ann & Robert H. Lurie Children's Hospital in Chicago and Primary Children's Hospital in Salt Lake City.

The test correctly detected acute intracranial hemorrhage because of AHT approximately 90 percent of the time, a much higher rate than the sensitivity of clinical judgement, which is approximately 70 percent. The test is not intended to replace clinical judgement, but researchers say it can supplement clinical evaluation.

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