Mild Traumatic Brain Injury: An Update for Advanced Practice Nurses

Esther Bay, PhD APRN BC CCRN; Samuel A. McLean, MD MPH


J Neurosci Nurs. 2007;39(1):43-51. 

In This Article

Biochemical Markers for Persons with Mild TBI

Because diagnostic and cognitive tests have limited ability to predict long-term outcomes for persons with MBI, investigators are focused on searching for biochemical markers that may be useful in diagnosis and prognosis. One area of research involves S100 proteins. These are present intracellularly and involved in calcium homeostasis, one of the biological mechanisms involved in brain trauma (Nygren-deBoussard et al., 2004). In a well-designed study of persons with MBI compared with a normal control group and a non-TBI trauma comparison group who were followed for 14 days, the investigators concluded that these biomarker proteins were not useful in detecting acute injuries but the S100AIB protein might be appropriate in identifying patients likely to experience long-term symptom progression (Townend, Guy, Pani, Martin, & Yates, 2002). Recently, scientists suggested that further study of the S100B protein in the management of MBI and sport-related concussion injury is required in order to predict who requires further diagnostic testing and management (Stalnacke, Tegner, & Sojka, 2004). Identification of biochemical markers sensitive in the detection and prognosis of MBI remains under investigation.

In summary, APNs are in regular contact with persons who may have experienced MBI. Expert interviewing and assessment is required to ascertain that the diagnosis is appropriate and that differentials are eliminated to the extent possible. Referrals to specialists may be required for further diagnostic testing or neuropsychological evaluation. Once there is a definitive diagnosis, a management plan can be developed and evaluated. Management of MBI is based on evidence-based practices.


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