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Notfalldiagnostik bei leichtem Schädel-Hirn-Trauma

Stellenwert des neuroglialen Proteins S100B

Emergency diagnostics for minor head trauma

Importance of neuroglial protein S100B

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Zusammenfassung

Hintergrund

Patienten mit „leichtem“ Schädel-Hirn-Trauma (SHT) erfordern wegen der potenziellen Gefahr einer intrakraniellen Blutung (ICB) eine besondere Berücksichtigung in der Notfallaufnahme. Für die Indikation zur initialen radiologischen Bildgebung existiert eine Vielzahl von z. T. erheblich divergierenden Empfehlungen. Ziel der vorliegenden Arbeit ist es, den Stellenwert des neuroglialen Proteins S100B für die Notfalldiagnostik zu bewerten.

Ziel

Evidenzbasierter Review mit der Fragestellung, ob im Rahmen der Notfalldiagnostik bei Patienten mit leichtem SHT S100B im Serum einsetzbar ist.

Material und Methode

Mittels systematischer Literaturrecherche in Pubmed, MEDLINE und manueller Recherche wurden relevante Publikationen zwischen Januar 1997 und August 2010 untersucht. Suchbegriffe waren: „head trauma“, „head injury“, „brain trauma“ oder „brain injury“ in Kombination mit „S100B“ bzw. „S-100B“.

Ergebnisse

Insgesamt konnten 17 relevante Arbeiten identifiziert werden. Acht prospektive Studien untersuchten die S100B als Screeningtest bei insgesamt 2082 Patienten mit leichtem Schädel-Hirn-Trauma. Sieben weitere Arbeiten analysierten den Zusammenhang zwischen Sport und S100B, 2 weitere Studien die prognostische Aussagekraft bei Zustand nach Reanimation. Bei Patienten mit leichtem SHT kann S100B im Serum mit einem Cut-off-Level von 0,1µg/l in Kombination mit klinischer Symptomatik und erhobenen Befunden als Screeningtest eingesetzt werden und ermöglich eine Reduktion von CCT-Anforderungen um etwa 30%.

Schlussfolgerung

Protein S100B ist in der klinischen Notfalldiagnostik bei leichtem Schädel-Hirn-Trauma zum Ausschluss einer intrakraniellen Blutung ausreichend untersucht und kann als diagnostisches Verfahren im klinischen Routinebetrieb zur Anwendung kommen. Für die Umsetzung in die notfallmedizinische Praxis wird ein Algorithmus vorgestellt.

Abstract

Context

For patients with minor head trauma there is the potential danger of intracranial hemorrhaging. However, current guidelines and recommendations incorporate various and divergent criteria for initial assessment and computed tomography.

Objective

The aim of this study was an assessment of neuroglial protein S100B as a screening test for minor head injuries.

Material and methods

A systematic search in Pubmed, MEDLINE and a manual search were carried out to review relevant articles published between January 1997 and August 2010. Keywords were “head trauma”, “head injury”, “brain trauma” or “brain injury” in combination with “S100B” or “S-100B”.

Results

We identified 17 relevant articles of which 8 prospective studies with combined 2,082 patients analyzed the possible use of S100B as a screening test for minor head trauma. The interaction between the serum level of protein S100BB and sports activities was analyzed in 7 studies and 2 studies analyzed the prognostic value of S100B for survival in cardiac arrest patients. A cut-off level of 0.1 µg/l S100B seemed to be safe enough to exclude a relevant intracranial injury resulting in a 30% reduction of cranial computed tomography (CCT) examinations.

Conclusion

For patients with minor head trauma protein S100B is suitable for routine use in emergency departments to rule out intracranial lesions and determine the need for CCT. An algorithm for the use of S100B in emergency departments is presented.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Campus Innenstadt, Klinikum der Universität München, Nussbaumstraße 20, 80336, München, Deutschland

    M. Zock, P. Biberthaler, W. Mutschler & K.-G. Kanz

  2. Interdisziplinäre Rettungsstelle, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland

    B.A. Leidel

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  1. M. Zock
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  2. B.A. Leidel
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  3. P. Biberthaler
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  4. W. Mutschler
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  5. K.-G. Kanz
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Correspondence to M. Zock.

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Zock, M., Leidel, B., Biberthaler, P. et al. Notfalldiagnostik bei leichtem Schädel-Hirn-Trauma. Notfall Rettungsmed 14, 261–267 (2011). https://doi.org/10.1007/s10049-011-1425-0

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