{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:03:20Z","timestamp":1777673000807,"version":"3.51.4"},"reference-count":34,"publisher":"IMR Press","issue":"4","license":[{"start":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T00:00:00Z","timestamp":1688688000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Integr. Neurosci."],"abstract":"<jats:p>Background: Paediatric Traumatic Brain Injury (TBI) has received less research attention compared to TBI in adults, despite its potential morbidity in all ages. Our aim was to determine whether neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and glucose levels at admission can reliably predict the need for imaging in children presenting with mild TBI. Methods: We retrospectively reviewed the clinical records of paediatric patients who presented in the emergency department with mild TBI within a 5 year period and had undergone computed tomography (CT) scan of the head. Results: Overall, 43 eligible patients were included in the study, with falls being the most commonly reported cause of injury. Twenty-three children had positive CT findings. Patients with abnormal CT findings were found to have higher NLR ratios compated with patients with normal CT, with the mean NLR on admission being 5.2 \u00b1 3.8. Children with abnormal CT findings had lower PLR levels and higher glucose levels at presentation compared to children with normal CT, however the differences were not statistically significant. Using the receiver operating characteristic (ROC) curve, we found that a NLR cut off value of 6.1 yielded a sensitivity of 54.2% and a specificity of 89.5% for the prediction of abnormal CT findings. Conclusions: The findings of this study suggest that NLR may have a role in CT decision-making in the emergency department for mild TBI in paediatric patients.<\/jats:p>","DOI":"10.31083\/j.jin2204091","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T08:48:52Z","timestamp":1688719732000},"source":"Crossref","is-referenced-by-count":10,"title":["Blood Biomarkers for Prediction of Positive CT Findings in Mild Traumatic Brain Injury in Paediatric Population"],"prefix":"10.31083","volume":"22","author":[{"given":"Timoleon","family":"Siempis","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pavlos A","family":"Georgalis","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios","family":"Lianos","sequence":"first","affiliation":[{"name":"Department of Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios","family":"Kafritsas","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Metaxas","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleutherios-Spyridon","family":"Alexiou","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiolanda","family":"Zika","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Sotiropoulos","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George A","family":"Alexiou","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spyridon","family":"Voulgaris","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2023,7,7]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Belisle S, Lim R, Hochstadter E, Sangha G. Approach to Pediatric Traumatic Brain Injury in the Emergency Department. Current Pediatric Reviews. 2018; 14: 4\u20138.","DOI":"10.2174\/1573396313666170815101258"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Dewan MC, Mummareddy N, Wellons JC, 3rd, Bonfield CM. Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review. World Neurosurgery. 2016; 91: 497\u2013509.e1.","DOI":"10.1016\/j.wneu.2016.03.045"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, et al. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet. 2017; 389: 2393\u20132402.","DOI":"10.1016\/S0140-6736(17)30555-X"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Eisenberg MA, Meehan WP, 3rd, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014; 133: 999\u20131006.","DOI":"10.1542\/peds.2014-0158"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Sheppard JP, Nguyen T, Alkhalid Y, Beckett JS, Salamon N, Yang I. Risk of Brain Tumor Induction from Pediatric Head CT Procedures: A Systematic Literature Review. Brain Tumor Research and Treatment. 2018; 6: 1\u20137.","DOI":"10.14791\/btrt.2018.6.e4"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR. American Journal of Roentgenology. 2001; 176: 289\u2013296.","DOI":"10.2214\/ajr.176.2.1760289"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Berger RP, Pierce MC, Wisniewski SR, Adelson PD, Kochanek PM. Serum S100B concentrations are increased after closed head injury in children: a preliminary study. Journal of Neurotrauma. 2002; 19: 1405\u20131409.","DOI":"10.1089\/089771502320914633"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Berger RP, Adelson PD, Richichi R, Kochanek PM. Serum biomarkers after traumatic and hypoxemic brain injuries: insight into the biochemical response of the pediatric brain to inflicted brain injury. Developmental Neuroscience. 2006; 28: 327\u2013335.","DOI":"10.1159\/000094158"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Fraunberger E, Esser MJ. Neuro-Inflammation in Pediatric Traumatic Brain Injury-from Mechanisms to Inflammatory Networks. Brain Sciences. 2019; 9: 319.","DOI":"10.3390\/brainsci9110319"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Mrakovcic-Sutic I, Tokmadzic VS, Laskarin G, Mahmutefendic H, Lucin P, Zupan Z, et al. Early changes in frequency of peripheral blood lymphocyte subpopulations in severe traumatic brain-injured patients. Scandinavian Journal of Immunology. 2010; 72: 57\u201365.","DOI":"10.1111\/j.1365-3083.2010.02407.x"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Alexiou GA, Lianos GD, Tzima A, Sotiropoulos A, Nasios A, Metaxas D, et al. Neutrophil to lymphocyte ratio as a predictive biomarker for computed tomography scan use in mild traumatic brain injury. Biomarkers in Medicine. 2020; 14: 1085\u20131090.","DOI":"10.2217\/bmm-2020-0150"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Li W, Deng W. Platelet-to-lymphocyte ratio predicts short-term mortality in patients with moderate to severe traumatic brain injury. Scientific Reports. 2022; 12: 13976.","DOI":"10.1038\/s41598-022-18242-4"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44: 837\u2013845.","DOI":"10.2307\/2531595"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Franco F, Di Napoli A. Evaluation of diagnostic tests in parallel and in series. Giornale di Tecniche Nefrologiche e Dialitiche. 2016; 28: 212\u2013215.","DOI":"10.5301\/GTND.2016.15992"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychological Bulletin. 2006; 132: 959\u2013992.","DOI":"10.1037\/0033-2909.132.6.959"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Rogers AJ, Maher CO, Schunk JE, Quayle K, Jacobs E, Lichenstein R, et al. Incidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics. 2013; 132: e356\u201363.","DOI":"10.1542\/peds.2013-0299"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Alexiou GA, Lianos GD, Alexiou ES, Voulgaris S. Biomarkers to safely discharge head trauma patients in the COVID-19 pandemic era. Biomarkers in Medicine. 2021; 15: 319\u2013321.","DOI":"10.2217\/bmm-2021-0008"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Amaranath JE, Ramanan M, Reagh J, Saekang E, Prasad N, Chaseling R, et al. Epidemiology of traumatic head injury from a major paediatric trauma centre in New South Wales, Australia. ANZ Journal of Surgery. 2014; 84: 424\u2013428.","DOI":"10.1111\/ans.12445"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Davey K, Saul T, Russel G, Wassermann J, Quaas J. Application of the Canadian Computed Tomography Head Rule to Patients With Minimal Head Injury. Annals of Emergency Medicine. 2018; 72: 342\u2013350.","DOI":"10.1016\/j.annemergmed.2018.03.034"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Nakhjavan-Shahraki B, Yousefifard M, Hajighanbari MJ, Oraii A, Safari S, Hosseini M. Pediatric Emergency Care Applied Research Network (PECARN) prediction rules in identifying high risk children with mild traumatic brain injury. European Journal of Trauma and Emergency Surgery. 2017; 43: 755\u2013762.","DOI":"10.1007\/s00068-017-0811-9"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Halaweish I, Riebe-Rodgers J, Randall A, Ehrlich PF. Compliance with evidence-based guidelines for computed tomography of children with head and abdominal trauma. Journal of Pediatric Surgery. 2018; 53: 748\u2013751.","DOI":"10.1016\/j.jpedsurg.2017.07.008"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Hazeldine J, Hampson P, Lord JM. The impact of trauma on neutrophil function. Injury. 2014; 45: 1824\u20131833.","DOI":"10.1016\/j.injury.2014.06.021"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Liu YW, Li S, Dai SS. Neutrophils in traumatic brain injury (TBI): friend or foe? Journal of Neuroinflammation. 2018; 15: 146.","DOI":"10.1186\/s12974-018-1173-x"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Holmes EJ, Misra RR. NICE Guideline for Paediatric CT Head. In Holmes, E.J., Misra, R.R. (eds.) Interpretation of Emergency Head CT: A Practical Handbook (pp. 133). 2nd edn. Cambridge University Press: Cambridge. 2017.","DOI":"10.1017\/9781316178881.031"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Alimohammadi E, Foroushani AZ, Moradi F, Ebrahimzadeh K, Nadersepahi MJ, Asadzadeh S, et al. Dynamics of neutrophil-to-lymphocyte ratio can be associated with clinical outcomes of children with moderate to severe traumatic brain injury: A retrospective observational study. Injury. 2022; 53: 999\u20131004.","DOI":"10.1016\/j.injury.2021.09.052"},{"key":"ref26","unstructured":"Marchese P, Lardone C, Canepele A, Biondi S, Roggi C, Massart F, et al. Pediatric traumatic brain injury: a new relation between outcome and neutrophil-to-lymphocite ratio. Acta Bio-medica: Atenei Parmensis. 2022; 92: e2021417."},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Kimball R, Shachar E, Eyerly-Webb S, Patel DM, Spader H. Using the neutrophil-to-lymphocyte ratio to predict outcomes in pediatric patients with traumatic brain injury. Clinical Neurology and Neurosurgery. 2020; 193: 105772.","DOI":"10.1016\/j.clineuro.2020.105772"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Alexiou GA, Sotiropoulos A, Lianos GD, Zigouris A, Metaxas D, Nasios A, et al. Blood Glucose Levels May Aid the Decision for CT Scan in Minor Head Trauma. Disease Markers. 2019; 2019: 1065254.","DOI":"10.1155\/2019\/1065254"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Alexiou GA, Tzima A, Lianos GD, Lampros M, Sotiropoulos A, Rizos D, et al. Neutrophil to lymphocyte ratio in the prediction of coagulopathy in traumatic brain injury. Biomarkers in Medicine. 2022; 16: 163\u2013168.","DOI":"10.2217\/bmm-2021-0582"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Alexiou GA, Lianos G, Fotakopoulos G, Michos E, Pachatouridis D, Voulgaris S. Admission glucose and coagulopathy occurrence in patients with traumatic brain injury. Brain Injury. 2014; 28: 438\u2013441.","DOI":"10.3109\/02699052.2014.888769"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Vlachos N, Lampros MG, Lianos GD, Voulgaris S, Alexiou GA. Blood biomarkers for predicting coagulopathy occurrence in patients with traumatic brain injury: a systematic review. Biomarkers in Medicine. 2022; 16: 935\u2013945.","DOI":"10.2217\/bmm-2022-0294"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Marzano LAS, Batista JPT, de Abreu Arruda M, de Freitas Cardoso MG, de Barros JLVM, Moreira JM, et al. Traumatic brain injury biomarkers in pediatric patients: a systematic review. Neurosurgical Review. 2022; 45: 167\u2013197.","DOI":"10.1007\/s10143-021-01588-0"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Babcock L, Byczkowski T, Mookerjee S, Bazarian JJ. Ability of S100B to predict severity and cranial CT results in children with TBI. Brain Injury. 2012; 26: 1372\u20131380.","DOI":"10.3109\/02699052.2012.694565"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Papa L, Zonfrillo MR, Ramirez J, Silvestri S, Giordano P, Braga CF, et al. Performance of Glial Fibrillary Acidic Protein in Detecting Traumatic Intracranial Lesions on Computed Tomography in Children and Youth With Mild Head Trauma. Academic Emergency Medicine. 2015; 22: 1274\u20131282.","DOI":"10.1111\/acem.12795"}],"container-title":["Journal of Integrative Neuroscience"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/JIN\/22\/4\/10.31083\/j.jin2204091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T16:06:45Z","timestamp":1732723605000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/JIN\/22\/4\/10.31083\/j.jin2204091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,7]]},"references-count":34,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023]]}},"alternative-id":["S0219-6352(23)00553-3"],"URL":"https:\/\/doi.org\/10.31083\/j.jin2204091","relation":{},"ISSN":["0219-6352","1757-448X"],"issn-type":[{"value":"0219-6352","type":"print"},{"value":"1757-448X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,7]]},"article-number":"91"}}