The Usefulness of Serum S-100 beta Levels as a Screening Test for Pediatric Minor Head Trauma

PURPOSE: It is well known that serum S-100 beta protein levels increased in adults after brain injury. However, there is no definite clinical data in children with isolated minor head trauma. The present study was conducted to validate S-100 beta protein levels as a screening test for brain damage in children with minor head trauma. METHODS: Serum S-100 beta protein levels were measured in 48 pediatric patients with minor head trauma. All patients had brain computed tomography (CT) scan to confirm brain injury. Data were analyzed using a contingency table and a receiver operating characteristic (ROC) curve to determine the diagnostic value of S-100 beta protein levels. RESULTS: Twelve (25%) patients had abnormal brain CT findings. Using a concentration cutoff value of 0.12 ug/L, patients with abnormal brain CT findings were identified by S-100 beta protein levels measurement with a sensitivity level of 100% and a specificity 38.9%. The area under the ROC curve for S-100 beta protein levels was 0.758 (95% CI, 0.606- 0.910). The number of high risk factors were 2.35+/-1.23 in the positive group and 1.53+/-0.76 in the negative group (p=0.011). CONCLUSION: Serum S-100 beta protein levels in children with minor head trauma were similar to those of adults. Our study supports the contention that rapid assessment of serum S-100 beta protein levels may reduce the use of brain CT in children with minor head trauma.

Epidemiology of Traumatic Accident Deaths

PURPOSE: Comparing the results of traffic accident deaths between ours and a previous study, we assessed the improvement in the emergency medical service system and the traumatic care system. METHODS: Three hundred twenty-one traumatic accident deaths occurring in Chunan and the nearby region between 1999 and 2000 were reviewed; data were obtained from paramedic trip reports, medical records, and radiological findings. RESULTS: One hundred fifty-eight (49%) deaths occurred in the prehospital setting. The remaining 163 (51%) patients were transported to the hospital. Of these, 89 (55%) died in the first 48 hours (acute), 26 (16%) within three to seven days (early) and 48 (29%) after seven days (late). Central nervous system injuries were the most frequent cause of death (57%), followed by exsanguination (25%) and organ failure (8%). Two distinct peaks of time were found on analysis: 50% of the patients died within the first 60 minutes, and 9% of the patients died at three to seven days after injury. The overall preventable death rate was 24%. CONCLUSION: Access to the prehospital emergency medical system was improved, and there was greater proportion of late deaths due to brain injury. We found the distribution to be a bimodal distribution.