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Brain Inj. 2018;32(1):29-40. doi: 10.1080/02699052.2017.1385097. Epub 2017 Nov 20.

Prognostic value of neuron-specific enolase (NSE) for prediction of post-concussion symptoms following a mild traumatic brain injury: a systematic review.

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a Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine , Université Laval , Québec , Canada.
b Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada.
c Emergency and Trauma Centre , The Alfred Hospital, Alfred Health , Melbourne , Australia.
d School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia.
e National Trauma Research Institute , The Alfred Hospital , Melbourne , VIC , Australia.
f Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Vieillissement, Centre de recherche du CHU de Québec , Université Laval , Québec , Canada.
g Département de Médecine Sociale et Préventive, Faculté de Médecine , Université Laval , Québec , Canada.
h Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS) , Québec , Québec , Canada.
i Research-Institute , McGill University Health Centre , Montreal , Québec , Canada.
j Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montréal , Québec , Canada.



This systematic review aimed to determine the prognostic value of neuron-specific enolase (NSE) to predict post-concussion symptoms following mild traumatic brain injury (TBI).


Seven databases were searched for studies evaluating the association between NSE levels and post-concussion symptoms assessed ≥ 3 months (persistent) or ≥ 7 days < 3 months (early) after mild TBI. Two researchers independently screened studies for inclusion, extracted data and appraised quality using the Quality in Prognostic Studies (QUIPS) tool.


The search strategy yielded a total of 23,298 citations from which 8 cohorts presented in 10 studies were included. Studies included between 45 and 141 patients (total 608 patients). The outcomes most frequently assessed were post-concussion syndrome (PCS, 12 assessments) and neuropsychological performance deficits (10 assessments). No association was found between an elevated NSE serum level and PCS. Only one study reported a statistically significant association between a higher NSE serum level and alteration of at least three cognitive domains at 2 weeks but this association was no longer significant at 6 weeks. Overall, risk of bias of the included studies was considered moderate.


Early NSE serum level is not a strong independent predictor of post-concussion symptoms following mild TBI.


Biomarker; neuron-specific enolase; post-concussion symptoms; post-concussion syndrome; systematic review; traumatic brain injury

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