title: The addition of S100B to guidelines for management of mild head injury is potentially cost saving.
abstract: BACKGROUND
  Mild traumatic brain injury (TBI) is associated with substantial costs due to over-triage of patients to computed tomography (CT) scanning, despite validated decision rules. Serum biomarker S100B has shown promise for safely omitting CT scans but the economic impact from clinical use has never been reported. In 2007, S100B was adapted into the existing Scandinavian management guidelines in Halmstad, Sweden, in an attempt to reduce CT scans and save costs.
  
  
  METHODS
  Consecutive adult patients with mild TBI (GCS 14-15, loss of consciousness and/or amnesia), managed with the aid of S100B, were prospectively included in this study. Patients were followed up after 3 months with a standardized questionnaire. Theoretical and actual cost differences were calculated.
  
  
  RESULTS
  Seven hundred twenty-six patients were included and 29 (4.7 %) showed traumatic abnormalities on CT. No further significant intracranial complications were discovered on follow-up. Two hundred twenty-nine patients (27 %) had normal S100B levels and 497 patients (73 %) showed elevated S100B levels. Over-triage occurred in 73 patients (32 %) and under-triage occurred in 39 patients (7 %). No significant intracranial complications were missed. The introduction of S100B could save 71 € per patient if guidelines were strictly followed. As compliance to the guidelines was not perfect, the actual cost saving was 39 € per patient.
  
  
  CONCLUSIONS
  Adding S100B to existing guidelines for mild TBI seems to reduce CT usage and costs, especially if guideline compliance could be increased.
authors.affiliation: Department of Paediatric Medicine, Halmstad Regional Hospital, Halmstad, Sweden. olga.calcagnile@regionhalland.se.|Barnkliniken, Hallandssjukhus Halmstad, 301 85, Halmstad, Sweden. olga.calcagnile@regionhalland.se.
authors.forename: Olga
authors.initials: O
authors.lastname: Calcagnile
authors.affiliation: Institute for economic research, Lund university school of economics and management, Lund, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Anell
authors.affiliation: Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Malmö, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Undén
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001924:Brain Concussion / Q000097:blood* / Q000000981:diagnostic imaging* / Q000191:economics*; D017046:Cost Savings; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D013548:Sweden; D055815:Young Adult
chemical_list: D015415:Biomarkers; D064568:S100 Calcium Binding Protein beta Subunit