Detection of traumatic brain injury with magnetic resonance imaging and S-100B protein in children, despite normal computed tomography of the brain.
OBJECTIVE
The objective of this study was to obtain data to further define the extent of traumatic brain injury by using S-100B protein and standard noncontrast magnetic resonance imaging with added fluid-attenuated inversion recovery (FLAIR) and gradient echo sequence in children with normal head computed tomography.


METHODS
Pilot, single cohort, prospective, clinical diagnostic study.


METHODS
Pediatric intensive care and intermediate care unit in a tertiary care children's hospital.


METHODS
Children ages 5-18 yrs who sustained traumatic brain injury, had a negative computed tomography of the brain, and were admitted to hospital were eligible for enrollment.


METHODS
Two blood samples were drawn for S-100B protein analysis: the first (t-1) as soon as possible or close to 6 hrs of injury and the second (t-2) close to 12 hrs from the time of injury. A magnetic resonance image of the brain was obtained within 96 hrs of injury.


RESULTS
Seven of 17 patients (41%) had positive magnetic resonance image. Of the seven patients with positive magnetic resonance image, 100% (seven of seven) had a positive magnetic resonance image with FLAIR sequence, 85% (six of seven) with axial T2 sequence and 50% (three of six) with gradient echo sequence. There was no statistically significant difference in S-100B protein concentrations in patients with a positive magnetic resonance image (n = 7) and those with a negative magnetic resonance image (n = 10; p =.40 at t-1 and p =.13 at t-2). The concentration of S-100B protein was statistically significantly higher in patients with head and other bodily injury (n = 9) compared with isolated head injury (n = 6; p =.018 at t-1 and p =.025 at t-2). Patients with a positive magnetic resonance image had a lower Glasgow Coma Scale score and longer duration of hospital stay.


CONCLUSIONS
Magnetic resonance imaging seems to be a useful modality to better define the spectrum of brain injury in children with mild head trauma. The addition of S-100B protein measurement does not seem to be useful in this setting.
Akhtar
Javed I
JI
Division of Pediatric Critical Care, Children's Hospital, San Diego, CA, USA. javed_akhtar@oz.ped.emory.edu
Spear
Robert M
RM
Senac
Mel O
MO
Peterson
Bradley M
BM
Diaz
Susan M
SM
D000293:Adolescent; D001930:Brain Injuries / Q000097:blood* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007902:Length of Stay; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009414:Nerve Growth Factors; D010865:Pilot Projects; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D014057:Tomography, X-Ray Computed
D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins