Reducing head computed tomography after mild traumatic brain injury: Screening value of clinical findings and S100B protein levels.

PRIMARY OBJECTIVE: The present prospective study was performed to investigate whether primary clinical findings and serum S100B concentrations at 3 and 6 hours post-trauma can contribute to the selection of patients for an initial computed tomography (CT) scanning. RESEARCH DESIGN AND METHODS: S100B was measured in serum samples obtained at 3 and 6 hours after the injury. Adjusted odds ratios (OR) and 95% confidence interval (CI) associated with demographics and clinical predictors of positive CT scan were calculated. Sensitivity, specificity, negative and positive predictive values were also calculated for S100B levels. MAIN OUTCOMES AND RESULTS: It was found that the presence of loss of consciousness (OR = 2.3; 95% CI = 1.00-4.01; p = 0.008) and post-traumatic vomiting ≥ 2 episodes (OR = 1.8; 95% CI = 1.08-3.29; p = 0.019) are factors associated with positive CT scan. In this study the best cut-off point of 0.115 µg L(-1) for 3-hour S100B has sensitivity of 94.9% (95% CI = 86.8-98.3) with specificity of 35.4% (95% CI = 25.2-47.0) to predict intracranial injury on CT scanning. The corresponding results for 6-hour S100B > 0.210 µg L(-1) were 98.7% (95% CI = 92.1-99.9) for sensitivity and 39.2% (95% CI = 28.6-50.8) for specificity. CONCLUSIONS: Serum S100B measurement along with clinical evaluation of patients with mild traumatic brain injury has promising screening value to support selection of patients for CT scanning.

Prediction of neuropsychological outcome after mild traumatic brain injury using clinical parameters, serum S100B protein and findings on computed tomography.

PRIMARY OBJECTIVE: To identify if demographics, clinical and computed tomographic (CT) characteristics at first presentation and S100B concentrations at 3 and 6 hours after mild traumatic brain injury (MTBI) predict the development of post-concussion syndrome (PCS) after 1 month. RESEARCH DESIGN AND METHODS: All consecutive MTBI patients (Glasgow Coma Scale [GCS] score 13-15) admitted to the Emergency Department aged older than 15 were included in this prospective, observational study. Outcome was assessed using a Rivermead Post-Concussion Symptoms Questionnaire to identify the patients with and without PCS 1 month after the injury. MAIN OUTCOMES AND RESULTS: A total of 176 patients with isolated MTBI were included in the study. After multivariate analysis of the demographics, clinical variables, and CT abnormalities, headache (OR = 2.09, 95% CI = 1.04-4.21, p = 0.038), seizure (OR = 5.64, 95% CI = 1.55-20.54, p = 0.009), the presence of subarachnoid haemorrhage on CT (OR = 3.67, 95% CI = 1.46-9.24, p = 0.006) and 6-hour S100B concentration (OR = 2.22, 95% CI = 1.15-4.28, p = 0.017) were independently significant predictors of the outcome. CONCLUSIONS: Outcome prediction using baseline characteristics (post-traumatic headache and seizure), CT and laboratory findings (6-hour S100B) were valuable factors for identification of the individual MTBI patient at risk for developing PCS 1 month after the injury.