Abstract
Background: S100B protein measurement in blood is proposed to exclude the presence of computed tomography (CT) lesions after minor head injury (MHI). We aimed to validate S100B as an accurate and valuable screening tool for MHI diagnosis in a large multicenter study, as well as: 1) to evaluate whether a second S100B blood level determination 3 h after the first one would be informative; 2) to compare the bioclinical performances of the two commercially available automated methods of measurement of S100B for the screening of patients.
Methods: Four thousand and thirty MHI subjects were enrolled in a prospective observational multicenter study; results for serum S100B measurement determined within 3 h after the clinical event (H0) then at H3 were compared to that of cranial CT scans performed with 6 h following the presentation to emergency department. Both the Diasorin and the Roche Diagnostics assays were systematically performed.
Results: Cerebral lesions on CT scan were identified with sensitivity and negative-predictive value (NPV) of 96.3% and 99.4% (Diasorin, 1 dissonant case), and of 100% and 100% (Roche Diagnostics, no dissonant case). Sensitivity and NPV at H3 appeared lower than those at H0, due to the rapid decrease in S100B levels.
Conclusions: Serum S100B level on admission of patients with MHI is an accurate and useful screening tool to exclude intracranial lesions. Performing a second late S100B level determination is not informative. The two automated immunoassays appear usable in a similar manner, although the two methods are not interchangeable.
Acknowledgments
This study was supported and funded by the STIC program of The French Ministry of Public Health, Paris, France, in favor of DRCD (Département de la Recherche Clinique et du Dévelopement) APHP-Ile-de France, France.
Conflict of interest statement
Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article. Research funding played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: J.-L. Beaudeux punctually receives fees for consulting from Roche Diagnostics.
References
1. Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO collaborating centre task force on mild traumatic brain injury. J Rehabil Med 2004;43: 28–60.10.1080/16501960410023732Search in Google Scholar PubMed
2. Smith-Bindman R. Is computed tomography safe? N Engl J Med 2010;363:1–4.10.1056/NEJMp1002530Search in Google Scholar PubMed
3. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000;343:100–5.10.1056/NEJM200007133430204Search in Google Scholar PubMed
4. Nash DL, Bellolio MF, Stead LG. S100 as a marker of acute brain ischemia: a systematic review. Neurocrit Care 2008;8:301–7.10.1007/s12028-007-9019-xSearch in Google Scholar PubMed
5. Metting Z, Wilczak N, Rodiger LA, Schaaf JM, van der Naalt J. GFAP and S100B in the acute phase of mild traumatic brain injury. Neurology 2012;78:1428–33.10.1212/WNL.0b013e318253d5c7Search in Google Scholar PubMed
6. Cervellin G, Benatti M, Carbucicchio A, Mattei L, Cerasti D, Aloe R, et al. Serum levels of protein S100B predict intracranial lesions in mild head injury. Clin Biochem 2012;45:408–11.10.1016/j.clinbiochem.2012.01.006Search in Google Scholar PubMed
7. Tavarez MM, Atabaki SM, Teach SJ. Acute evaluation of pedriatric patients with minor traumatic brain injury. Curr Opin Pediatr 2012;24:307–13.10.1097/MOP.0b013e3283531ce6Search in Google Scholar PubMed
8. Egea-Guerrero JJ, Revuelto-Rey J, Murillo-Cabezas F, Munoz-Sanchez MA, Vilches-Arenas A, Sanchez-Linares P, et al. Accuracy of the S100B protein as a marker of brain damage in traumatic brain injury. Brain Inj 2012;26:76–82.10.3109/02699052.2011.635360Search in Google Scholar PubMed
9. Unden J, Romner B. Can low serum levels of S100B predict normal CT findings after minor head injury in adults?: an evidence-based review and meta-analysis. J Head Trauma Rehabil 2010;25:228–40.10.1097/HTR.0b013e3181e57e22Search in Google Scholar PubMed
10. Townend W, Dibble C, Abid K, Vail A, Sherwood R, Lecky F. Rapid elimination of protein S100B from serum after minor head injury. J Neurotrauma 2006;23:149–55.10.1089/neu.2006.23.149Search in Google Scholar PubMed
11. Jonsson H, Johnsson P, Hoglund P, Alling C, Blomquist S. Elimination of S100B and renal function after cardiac surgery. J Cardiothorac Vasc Anesth 2000;14:698–701.10.1053/jcan.2000.18444Search in Google Scholar PubMed
12. Morochovic R, Racz O, Kitka M, Pingorova S, Cibur P, Tomkova D, et al. Serum S100B protein in early management of patients after mild traumatic brain injury. Eur J Neurol 2009;16:1112–7.10.1111/j.1468-1331.2009.02653.xSearch in Google Scholar PubMed
13. Bouvier D, Oddoze C, Ben Haim D, Moustafa F, Legrand A, Alazia M, et al. Interest of S100B protein blood level determination for the management of patients with minor head traum. Ann Biol Clin (Paris) 2009;67:425–31.Search in Google Scholar
14. Poli-de-Figueiredo LF, Biberthaler P, Simao Filho C, Hauser C, Mutschler W, Jochum M. Measurement of S-100B for risk classification of vitims sustaining minor head injury – First pilot study in Brazil. Clinics (Sao Paulo) 2006;61:41–6.10.1590/S1807-59322006000100008Search in Google Scholar
15. Bazarian JJ, Beck C, Blyth B, von Ahsen N, Hasselblatt M. Impact of creatine kinase correction on the predictive value of S100B after mild traumatic brain injury. Restor Neurol Neurosci 2006;24:163–72.Search in Google Scholar
16. Biberthaler P, Linsenmeier U, Pfeifer KJ, Kroetz M, Mussack T, Kanz KG, et al. Serum S-100B concentration provides additional information for the indication of computed tomography in patients after minor head injury: a propsective multicentre study. Shock 2006;25:446–53.10.1097/01.shk.0000209534.61058.35Search in Google Scholar PubMed
17. Nygren de Boussard C, Fredman P, Lundin A, Andersson K, Edman G, Borg J. S100 in mild traumatic brain injury. Brain Inj 2004;18:671–83.10.1080/02699050310001646215Search in Google Scholar PubMed
18. Mussack T, Biberthaler P, Kanz KG, Heckl U, Gruber R, Linsenmaier U, et al. Immediate S-100B and neuron-specific enolase plasma measurements for rapid evaluation of primary brain damage in alcohol-intoxicated, minor head-injured patients. Shock 2002;18:395–400.10.1097/00024382-200211000-00002Search in Google Scholar PubMed
19. Biberthaler P, Mussack T, Wiedemann E, Kanz KG, Mutschler W, Linsenmaier U, et al. Rapid identification of high-risk patients after minor head traum (MHT) by assessment of S-100B: ascertainement of a cut-off level. Eur Med Res J 2002;7: 164–70.Search in Google Scholar
20. Biberthaler P, Mussack T, Wiedemann E, Kanz KG, Koelsch M, Gippner-Steppert C, et al. Evaluation of S-100b as a specific marker for neuronal damage due to minor head trauma. World J Surg 2001;25:93–7.10.1007/s002680020370Search in Google Scholar PubMed
21. Ingebrigtsen T, Romner B, Marup-Jensen S, Dons M, Lundqvist C, Bellner J, et al. The clinical value of serum S-100 protein measurements in minor head injury: a Scandinavian multicentre study. Brain Inj 2000;14:1047–55.10.1080/02699050050203540Search in Google Scholar PubMed
22. Ingebrigtsen T, Waterloo K, Jacobsen EA, Langbakk B, Romner B. Traumatic brain damage in minor head injury: relation of serum S-100 protein measurements to magnetic resonance imaging and neurobehavorial outcome. Neurosurgery 1999;45:468–75.10.1097/00006123-199909000-00010Search in Google Scholar PubMed
23. Zongo D, Ribéreau-Gayon R, Masson F, Laborey M, Contrand B, Salmi LR, et al. S100-B protein as a screening tool for the early assessment of minor head injury. Ann Emerg Med 2012;59: 209–18.10.1016/j.annemergmed.2011.07.027Search in Google Scholar PubMed
24. Bouvier D, Fournier M, Dauphin JB, Amat F, Ughetto S, LabbéA, et al. Serum S100B determination in the management of pediatric mild traumatic brain injury. Clin Chem 2012;58: 1116–22.10.1373/clinchem.2011.180828Search in Google Scholar PubMed
25. Oh EJ, Kim YM, Jegal DW, Kahng J, Park YJ, Han K. Diagnostic value of Elecsys S100 as a marker of acute brain injury in the emergency department. J Clin Lab Anal 2007;21:387–92.10.1002/jcla.20201Search in Google Scholar PubMed PubMed Central
26. Pickering A, Carter J, Hanning I, Townend W. Emergency department measurement of urinary S100B in children following head injury: can extracranial injury confound findings? Emerg Med J 2008;25:88–9.10.1136/emj.2007.046631Search in Google Scholar PubMed
27. Unden J, Bellner J, Eneroth M, Alling C, Ingebrigtsen T, Romner B. Raised serum S100B levels after acute bone fractures without cerebral injury. J Trauma 2005;58:59–61.10.1097/01.TA.0000130613.35877.75Search in Google Scholar
28. Pham N, Fazio V, Cucullo L, Teng Q, Biberthaler P, Bazarian JJ, et al. Extracranial sources so S100B do not affect serum levels. Plos One 2010;5:e12691.10.1371/journal.pone.0012691Search in Google Scholar PubMed PubMed Central
29. Sloan EP, Zalenski RJ, Smith RF, Sheaff CM, Chen EH, Keys NI, et al. Toxicology screening in urban trauma patients: drug prevalence and its relationship to trauma severity and management. J Trauma 1989;29:1647–53.10.1097/00005373-198912000-00011Search in Google Scholar
30. Lange RT, Iverson GL, Brubacher JR. Clinical utility of the protein S100B to evaluate traumatic brain injury in the presence of acute alcohol intoxication. J Head Trauma Rehabil 2012;27:123–34.10.1097/HTR.0b013e31820e6840Search in Google Scholar PubMed
31. Enochsson L, Carlsson-Sanz S, van der Linden J. The influence of alcohol and time on the S-100B levels of patients with minor head injury. Eur J Neurol 2005;12:445–8.10.1111/j.1468-1331.2005.00996.xSearch in Google Scholar PubMed
32. Einav S, Itshayek E, Kark JD, Ovadia H, Weiniger CF, Shoshan Y. Serum S100B levels after meningioma surgery: a comparison of two laboratory assays. BMC Clin Pathol 2008;19:8–9.10.1186/1472-6890-8-9Search in Google Scholar PubMed PubMed Central
33. Muller K, Elverland A, Romner B, Waterloo K, Langbakk B, Undén J, et al. Analysis of protein S100B in serum: a methodological study. Clin Chem Lab Med 2006;44:1111–4.10.1515/CCLM.2006.211Search in Google Scholar PubMed
34. Erickson JA, Grenache DG. Comparison of three assays for quantifying S100B in serum. Clin Chim Acta 2011;412:2122–7.10.1016/j.cca.2011.07.020Search in Google Scholar PubMed
35. Calcagnile O, Unden L, Unden J. Clinical validation of S100B use in management of mild head injury. BMC Emerg Med 2012;12:13.10.1186/1471-227X-12-13Search in Google Scholar PubMed PubMed Central
36. Bloomfield SM, McKinney J, Smith L, Brisman J. Reliability of S100B in predicting severity of central nervous system injury. Neurocrit Care 2007;6:121–38.10.1007/s12028-007-0008-xSearch in Google Scholar PubMed
37. Nylén K, Ost M, Csajbok LZ, Nilsson I, Hall C, Blennow K, et al. Serum levels of S100B, S100A1B and S100BB are all related to outcome after severe traumatic brain injury. Acta Neurochir 2008;150:221–7.10.1007/s00701-007-1489-2Search in Google Scholar PubMed
38. Topolovec-Vranic J, Pollmann-Mudryj MA, Ouchterlony D, Klein D, Spence J, Romaschin A, et al. The value of serum biomarkers in prediction models of outcome after mild traumatic brain injury. J Trauma 2011;71:S478–86.10.1097/TA.0b013e318232fa70Search in Google Scholar PubMed
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