Disclosures: Margaret O. Martinez: No financial relationships or conflicts of interest

Objective: Although pediatric Abusive Head Trauma (AHT) is associated with significant morbidity and mortality, it is significantly understudied. Further, these cases are a diagnostic challenge, especially given potentially dire consequences of returning these children to a hostile environment. Thus, there is an urgent, unmet need to quickly, specifically and objectively make the diagnosis of AHT. To date, there are no biomarkers that are sufficiently sensitive to detect abusive head injury, determine the recovery trajectory, and aid in developing plans for management. Osteopontin (OPN), an inflammatory cytokine indicative of microglia activation, has been shown to predict severity in traumatic brain injury (TBI) and may be a potential marker for abuse. This study aims to evaluate the ability of OPN levels to distinguish between AHT from other mechanisms of TBI. The study additionally explores the relationship between AHT and rehabilitation outcomes.

Design: Case-controlled study.

Setting: Children’s Hospital

Participants: 79 pediatric TBI patients (ages 0-4); 24 confirmed AHT and 55 accidental trauma. Of these, 59 completed inpatient rehabilitation. Blood was drawn within 6 hours of admission and at 24 hours, 48 hours and 72 hours to measure for OPN levels. WeeFIM ratings were collected at admission and discharge from inpatient rehabilitation.

Interventions: N/A

Main Outcome Measures: OPN levels, WeeFIM

Results: No differences in Glasgow coma score (GCS) across groups (6.25 vs. 6.56). AHT group was younger (mean age .65 vs. 2.36 years). Higher OPN levels found in AHT at admission (P=.005) and 72 hours (P=.015) compared to accidental trauma group. AHT group showed less improvement (mean WeeFIM change 4.73 vs. 18.48) during inpatient rehabilitation as measured by WeeFIM scores (t(30) = 2.406, P =.02).

Conclusions: OPN may serve as an objective indicator to support a diagnosis of AHT and allow appropriate acute intervention. Additionally, a more accurate diagnosis of AHT could help physiatrists to anticipate recovery patterns and inform treatment decisions among survivors.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/plasma-osteopontin-levels-as-a-biomarker-for-abuse-in-traumatic-brain-injuries/