Biomarker S100B in plasma a screening tool for mild traumatic brain injury in an emergency department

ABSTRACT

Introduction

A computerized tomography (CT) scan is an effective test for detecting traumatic intracranial findings after mild traumatic brain injury (mTBI). However, a head CT is costly, and can only be performed in a hospital.

Objective

To determine if the addition of plasma S100B to clinical guidelines could lead to a more selective scanning strategy without compromising safety.

Methods

We conducted a single center prospective cohort study at the emergency department. Patients (≥16 years) who received head CT and had a blood draw were included. The primary outcome was the accuracy of plasma S100B to predict the presence of any traumatic intracranial lesion on head CT.

Results

We included 495 patients, out of the 74 patients who had traumatic intracranial lesions, 5 patients had a plasma S100B level below the cutoff value of 0.105 ug/L. For the detection of traumatic intracranial injury, S100B had a sensitivity of 0.932 , a specificity of 0.157, a negative predictive value of 0.930, and a positive predictive value of 0.163.

Conclusions

Among patients undergoing guideline-based CT scan for mTBI, the use of S100B, would results in a further decrease (14.8%) of CT scans but at a cost of missed injury, without clinical consequence, on CT.

KEYWORDS:

• Mild traumatic brain injury
• S100B
• emergency department
• screening tool
• head CT

Acknowledgments

Author Contribution

Santing and Hopman contributed equally to this work. Van den Brand and Jellema conceived and designed the study and obtained research funding. Hopman, Santing, and van den Brand supervised the conduct of the study and data collection. Verheul was the clinical chemist responsible for the S100B measurement. Hopman and Santing managed the data, including quality control, Hopman, Santing, and van der Linden analyzed the data. Hopman and Santing drafted the article, and all authors contributed substantially to its revision.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding

This study was supported by Roche Diagnostics. They had no role in the design, conduct, analysis, or content of this research or article.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2022.2145360