S100B serum level: A relevant biomarker for the management of non-traumatic headaches in emergency care?

BACKGROUND: The diagnostic of primary or secondary headaches in emergency units is mostly based on brain imaging, which is expensive and sometimes hardly accessible. An increase in serum S100B protein has already been found in several neurological conditions inducing brain damage. The objective of this study was to assess the diagnostic performance of S100B serum assay to distinguish primary and secondary headaches among patients with non-traumatic headaches in the emergency department. METHODS: This was a phase 2, prospective, monocentric diagnostic study. Eighty-one adult patients with non-traumatic headaches in the emergency department were included. In addition to the usual management, a blood assay of the S100B protein was performed in the emergency department, as well as a brain MRI between 48 and 96 h if not performed during the initial management. The primary or secondary headache diagnosis was made at one month by an expert committee, blindly of the results of the S100B assay. The primary outcome was the blood assay of the S100B protein. RESULTS: There was 63 patients for analysis in the primary headache group and 17 in the secondary headache group. The S100B protein assay was significantly higher in secondary headaches than primary headaches, with an AUC of the ROC curve of 0.67. The optimal threshold of 0.06 µg.L-1 allowed to obtain those diagnostic characteristics: sensitivity 75% [48; 93], specificity 62% [48; 74], PPV 35% [20; 54] and NPV 90% [76; 97]. The association between the S100B protein level and the onset of pain was significantly higher for patients with headaches <3 h. CONCLUSION: The assay of the S100B protein could be useful in the management of this pathology in emergencies. Future studies taking into account dosing time and etiologies could be conducted in order to refine its use in practice.

Pocket-sized ultrasound device for internal jugular puncture: A randomized study of performance on a simulation model.

INTRODUCTION: The aims of our study were to compare the performance of experienced emergency physicians for internal jugular vein puncture using a conventional ultrasound device versus a pocket-sized ultrasound in a training model. METHODS: In this single-center, prospective, randomized study, emergency physicians performed one puncture with each device in a randomized order. No emergency physicians used a pocket-sized ultrasound for central vascular catheter insertion in clinical practice. A medium-fidelity training model was used. Each image was judged based on an image quality scale from 0 to 5. RESULTS: Twenty emergency physicians were included: nine females (45%), median experience 2.5 years [2.0;4.3]. The median time to achieve a puncture with the conventional ultrasound device was 22 s [17;26] versus 28 s [13;43] with the pocket-sized ultrasound (p = 0.43). Eighteen (90%) emergency physician punctures were successful with the conventional ultrasound device versus 18 (90%) with the pocket-sized ultrasound (p = 1). The image quality was 4 [3;5] in the conventional ultrasound device group versus 4 [3;5] in the pocket-sized ultrasound group (p = 0.32). CONCLUSION: Pocket-sized ultrasound and conventional ultrasound device performances are not statistically different for internal jugular vein-guided ultrasonography in a training model. These results must be confirmed in a clinical study.