A new objective method for CT triage after minor head injury--serum S100B.
The risk of acute intracranial complication after minor head injury (MHI) is low. Despite this, a computed tomography (CT) scan is generally recommended for all patients following MHI. Admission for clinical observation is a secondary management option when a CT scan is unavailable or is judged inappropriate. Both alternatives are associated with disadvantages and several attempts at refining existing guidelines for MHI management have been proposed as a means of reducing CT and/or admission. However, they are based on potentially unreliable patient history and clinical examination and, furthermore, may be compromised by patient factors such as intoxication. Clinical studies from several research groups have shown the potential of brain biomarker S100B in this patient category. The specificity of S100B is poor, but a high sensitivity for brain damage effectively rules out relevant complications after MHI. Used in conjunction with existing guidelines, serum levels of S100B can accurately identify patients who do not need a CT scan after MHI. Based on 6 prospective studies comprising almost 2,000 patients with MHI, the sensitivity and negative predictive value of S100B for CT findings were 98.2% and 99.5%, respectively, and for clinically relevant intracranial complications 100% and 100%, respectively. Integration of S100B within existing management routines can reduce the need for CT scans by 30%, resulting in improved and more efficient patient care.
Undén
Johan
J
Department of Anesthesia and Intensive Care, Halmstad County Hospital, Halmstad, Sweden.
Romner
Bertil
B
D015415:Biomarkers / Q000097:blood; D006259:Craniocerebral Trauma / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D006287:Health Planning Guidelines; D006801:Humans; D009418:S100 Proteins / Q000097:blood*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014218:Triage / Q000379:methods*
D015415:Biomarkers; D009418:S100 Proteins