Assessing bicycle-related trauma using the biomarker S100B reveals a correlation with total injury severity.
OBJECTIVE
Worldwide, the use of bicycles, for both recreation and commuting, is increasing. S100B, a suggested protein biomarker for cerebral injury, has been shown to correlate to extracranial injury as well. Using serum levels of S100B, we aimed to investigate how S100B could be used when assessing injuries in patients suffering from bicycle trauma injury. As a secondary aim, we investigated how hospital length of stay and injury severity score (ISS) were correlated to S100B levels.


METHODS
We performed a retrospective, database study including all patients admitted for bicycle trauma to a level 1 trauma center over a four-year period with admission samples of S100B (n = 127). Computerized tomography (CT) scans were reviewed and remaining data were collected from case records. Univariate- and multivariate regression analyses, linear regressions and comparative statistics (Mann-Whitney) were used where appropriate.


RESULTS
Both intra- and extracranial injuries were correlated with S100B levels. Stockholm CT score presented the best correlation of an intracranial parameter with S100B levels (p < 0.0001), while the presences of extremity injury, thoracic injury, and non-cervical spinal injury were also significantly correlated (all p < 0.0001, respectively). A multivariate linear regression revealed that Stockholm CT score, non-cervical spinal injury, and abdominal injury all independently correlated with levels of S100B. Patients with a ISS > 15 had higher S100 levels than patients with ISS < 16 (p < 0.0001). Patients with extracranial, as well as intracranial- and extracranial injuries, had significantly higher levels of S100B than patients without injuries (p < 0.05 and p < 0.01, respectively). The admission serum levels of S100B (log, µg/L) were correlated with ISS (log) (r = 0.53) and length of stay (log, days) (r = 0.45).


CONCLUSIONS
S100B levels were independently correlated with intracranial pathology, but also with the extent of extracranial injury. Length of stay and ISS were both correlated with the admission levels of S100B in bicycle trauma, suggesting S100B to be a good marker of aggregated injury severity. Further studies are warranted to confirm our findings.
Section for Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Solna, R2:02, 171 76, Stockholm, Sweden. eric.thelin@ki.se.
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Thelin
Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.|Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.
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Zibung
Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.|Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.
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Riddez
Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.|Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.
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Nordenvall
D000328:Adult; D001642:Bicycling / Q000293:injuries*; D015415:Biomarkers / Q000097:blood; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D013548:Sweden; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000097:blood* / Q000175:diagnosis*
D015415:Biomarkers; D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human
Assessment tools; Bicycle trauma; Biomarkers; CT scanning; Emergency care; S100B; Traumatic brain injury