Diagnostic performance of S100B protein serum measurement in detecting intracranial injury in children with mild head trauma.
OBJECTIVE
To assess the accuracy of S100B serum level to detect intracranial injury in children with mild traumatic brain injury.


METHODS
A multicenter prospective cohort study was carried out in the paediatric emergency departments of three tertiary hospitals in Switzerland between January 2009 and December 2011. Participants included children aged <16 years with a mild traumatic brain injury (GCS ≥13) for whom a head CT was requested by the attending physician. Venous blood was obtained within 6 h of the trauma in all children for S100B measurement before a head CT was performed. As the S100B value was not available during the acute care period, the patient's management was not altered. The main measures were protein S100B value and the CT result.


RESULTS
20/73 (27.4%) included children had an intracranial injury detected on CT. S100B receiver operating characteristics area under the curve was 0.73 (95% CI 0.60 to 0.86). With a 0.14 µg/L cut-off point, S100B reached an excellent sensitivity of 95% (95% CI 77% to 100%) and 100% (95% CI 81% to 100%) in all children and in children aged >2 years, respectively. The specificity, however, was 34% (95% CI 27% to 36%) and 37% (95% CI 30% to 37%), respectively.


CONCLUSIONS
S100B has an excellent sensitivity but poor specificity. It is therefore an accurate tool to help rule out an intracranial injury but cannot be used as the sole marker owing to its specificity. Used with clinical decision rules, S100B may help to reduce the number of unnecessary CT scans.
Pediatric Emergency Department, Geneva University Hospital, Geneva, Switzerland.
Sergio
http://orcid.org/0000-0001-9603-5520
S
Manzano
Pediatric Emergency Department, University Children's Hospital, Zurich, Switzerland.
Iris Bachmann
IB
Holzinger
Department of Diagnostic Imaging, University Children's Hospital, Zürich, Switzerland.
Christian J
CJ
Kellenberger
Pediatric Emergency Department, Geneva University Hospital, Geneva, Switzerland.
Laurence
L
Lacroix
Department of Pediatric Surgery, Ostschweizer Children's Hospital, St. Gallen, Switzerland.
Dagmar
D
Klima-Lange
Division of Clinical Chemistry and Biochemistry, University Children's Hospital, Zurich, Switzerland.
Martin
M
Hersberger
Pediatric Surgery Department, Geneva University Hospital, Geneva, Switzerland.
Giorgio
G
La Scala
Pediatric Surgery Department, University Children's Hospital, Zurich, Switzerland.
Stefan
S
Altermatt
Pediatric Emergency Department, University Children's Hospital, Zurich, Switzerland.
Georg
G
Staubli
D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood* / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D012680:Sensitivity and Specificity; D013557:Switzerland; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D064568:S100 Calcium Binding Protein beta Subunit
Trauma, head; diagnosis; paediatric emergency med