RESUMEN
Head injury is recognized as a major public health problem that is a frequent cause of death and disability in young people and makes a considerable demands on health services. The aim of the present study was to assess the severity and outcome of patients with head injuries using a new serum marker which is the level of S-100 B protein, in addition to the use of Glasgow Coma Scale [GCS], brain computed tomography [CT] findings and the Glasgow Outcome Scale [GOS]. The study was conducted on fifty patients with head injury [moderate and severe] who were admitted to the Critical Care Medicine Department [CCMD] at Alexandria Main University Hospital [AMUH] during the period from 1[st] March till the end of June 2004. Ten healthy adult individuals of both sexes were chosen and matched with patients of the present study as regards age and sex. They served as a control group when measuring S-100 B protein level. All patients were subjected to complete history taking with emphasis on causes of head injury, and clinical examination especially neurological examination using Glasgow Coma Scale [GCS]. Serum level of S-100 B protein was measured within six hours from the onset of head trauma, using ELISA technique. Radiological assessment included X-ray skull and computed tomography [CT] of the brain. The outcome of the patients was determined using the Glasgow Outcome Scale [GOS]. The present study revealed that the age of patients with head injuries ranged from 15-60 years with a mean age of 33.7+14.2 years. Male to female sex ratio was 5.25: 1. Road traffic accidents [RTAs] constituted the main cause of head injury [74.0%]. More than half the patients [58%] had open head injuries, while 42.0% had closed head injuries. Severe head injury [GCS=3-8] was encountered in 84.0% of patients, while moderate head injury [GCS=9-12] was evident in 16.0%. More than one quarter of the patients [26.0%] had skull fractures. Brain lesions demonstrated by CT scan was found in 86.0% of the patients while normal CT brain was reported in 14.0%. In patients with head injuries, S-100B protein level ranged from 0.7 to 4.5 mirco g/L with a mean level 1.8 +/- 1.5 mirco g/L, which was significantly higher than the mean serum level of the control group [0.1 +/- 0.02 mirco g/L]. A significant rise of serum S-100B protein level was related to severe head injuries assessed by GCS, posttraumatic amnesia [PTA] more than one week, absence of spontaneous ventilation, abnormal brain findings demonstrated by C T scan, and associated injuries especially thoracic trauma. More than half the patients showed poor outcome by GOS [60.0%], while those with good outcome [good recovery. and moderate disability] accounted for 40.0%. Serum S-100B protein level was significantly higher in patients with poor outcome than in those with good outcome using GOS. The study concluded that the admission level of S-100B protein is a useful early predictive marker in determination of the outcome [disability and mortality] after head injury