Head injury outcome prediction in the emergency department: a role for protein S-100B?
BACKGROUND
Biochemical markers released after head injury may reflect the degree of brain damage, which is related to subsequent disability. If the serum level of a marker were found to be related to outcome, then earlier identification and intervention would be possible.


OBJECTIVE
To investigate the potential of the serum marker S-100B protein to predict the outcome after head injury.


METHODS
Blood samples for S-100B concentrations were taken from 148 adults within six hours of a head injury (initial Glasgow coma score 4-15). Patients were recruited from the emergency departments of four hospitals in Greater Manchester, United Kingdom. Outcome was assessed in 119 patients (80%) at one month using the extended Glasgow outcome scale (GOSE).


RESULTS
A significant inverse correlation between serum S-100B level and GOSE was found (Spearman's rho = -0.349, p < 0.0001). A serum S-100B concentration of > 0.32 micro g/l predicted severe disability (GOSE < 5) at one month with a sensitivity of 93% (95% confidence interval 68% to 100%), a specificity of 72% (54% to 79%), and a negative predictive value of 99% (93% to 100%).


CONCLUSIONS
Serum S-100B concentration can be used in the emergency department to identify patients with head injury who are most likely to have a poor outcome at one month.
Townend
W J
WJ
Emergency Department, Hope University Hospital, Salford, UK. fs1.ho.man.ac.uk
Guy
M J
MJ
Pani
M A
MA
Martin
B
B
Yates
D W
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001930:Brain Injuries / Q000097:blood / Q000378:metabolism* / Q000534:rehabilitation*; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D009418:S100 Proteins / Q000378:metabolism*
D015415:Biomarkers; D009418:S100 Proteins