Serum amyloid A is increased in children with abusive head trauma: a gel-based proteomic analysis

BACKGROUND: Abusive head trauma (AHT) is the leading cause of death from traumatic brain injury in infants and young children. Identification of mild AHT (Glasgow Coma Scale score: 13-15) is difficult because children can present with nonspecific symptoms and with no history of trauma. METHODS: Two-dimensional difference gel electrophoresis combined with mass spectrometry was used to compare the serum protein profile of children with Mild AHT and age-matched controls. Protein changes were confirmed by western blots. Western blots were performed using serum from children with mild, moderate, and severe AHT to assess the effect of injury severity on protein intensity. The protein identified serum amyloid A (SAA) was then measured by enzyme-linked immunosorbent assay. RESULTS: Using serum from 18 mild AHT cases and 20 controls, there were similar to 1,000 protein spots; 2 were significantly different between groups. Both spots were identified as SAA. There was no relationship between protein levels and injury severity. SAA concentrations measured by enzyme-linked immunosorbent assay were increased in cases vs. controls. CONCLUSION: SAA may be a potential biomarker to identify children with mild AHT who present for medical care without a history of trauma and who might otherwise not be recognized as needing a head computed tomography.