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S100-B Protein as a Screening Tool for the Early Assessment of Minor Head Injury

  • Drissa Zongo
    Correspondence
    Address for correspondence: Drissa Zongo, MD, MPH
    Affiliations
    Service des Urgences Adultes, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    Institut de Santé Publique, d'Epidémiologie et de Développement, Université Bordeaux Segalen, Bordeaux, France

    Equipe “Prévention et Prise en Charge des Traumatismes,” Institut National de la Santé et de la Recherche Médicale Unité 897, Bordeaux, France
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  • Régis Ribéreau-Gayon
    Affiliations
    Service des Urgences Adultes, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    Equipe “Prévention et Prise en Charge des Traumatismes,” Institut National de la Santé et de la Recherche Médicale Unité 897, Bordeaux, France
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  • Françoise Masson
    Affiliations
    Service d'Anesthésie-Réanimation, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    Equipe “Prévention et Prise en Charge des Traumatismes,” Institut National de la Santé et de la Recherche Médicale Unité 897, Bordeaux, France
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  • Magali Laborey
    Affiliations
    Institut de Santé Publique, d'Epidémiologie et de Développement, Université Bordeaux Segalen, Bordeaux, France

    Equipe “Prévention et Prise en Charge des Traumatismes,” Institut National de la Santé et de la Recherche Médicale Unité 897, Bordeaux, France
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  • Benjamin Contrand
    Affiliations
    Institut de Santé Publique, d'Epidémiologie et de Développement, Université Bordeaux Segalen, Bordeaux, France

    Equipe “Prévention et Prise en Charge des Traumatismes,” Institut National de la Santé et de la Recherche Médicale Unité 897, Bordeaux, France
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  • Louis Rachid Salmi
    Affiliations
    Service d'information médicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    Institut de Santé Publique, d'Epidémiologie et de Développement, Université Bordeaux Segalen, Bordeaux, France

    Equipe “Prévention et Prise en Charge des Traumatismes,” Institut National de la Santé et de la Recherche Médicale Unité 897, Bordeaux, France
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  • Danièle Montaudon
    Affiliations
    Service de Neuroradiologie diagnostique et thérapeutique, the Laboratoire de Biochimie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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  • Jean Louis Beaudeux
    Affiliations
    Laboratoire de Biochimie, Hôpital Charles Foix (APHP), Paris, France
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  • Antoine Meurin
    Affiliations
    Service de Neuroimagerie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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  • Vincent Dousset
    Affiliations
    Service de Neuroimagerie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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  • Hugues Loiseau
    Affiliations
    Service de Neurochirurgie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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  • Emmanuel Lagarde
    Affiliations
    Institut de Santé Publique, d'Epidémiologie et de Développement, Université Bordeaux Segalen, Bordeaux, France

    Equipe “Prévention et Prise en Charge des Traumatismes,” Institut National de la Santé et de la Recherche Médicale Unité 897, Bordeaux, France
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      Study objective

      A computed tomography (CT) scan has high sensitivity in detecting intracranial injury in patients with minor head injury but is costly, exposes patients to high radiation doses, and reveals clinically relevant lesions in less than 10% of cases. We evaluate S100-B protein measurement as a screening tool in a large population of patients with minor head injury.

      Methods

      We conducted a prospective observational study in the emergency department of a teaching hospital (Bordeaux, France). Patients with minor head injury (2,128) were consecutively included from December 2007 to February 2009. CT scans and plasma S100-B levels were compared for 1,560 patients. The main outcome was to evaluate the diagnostic value of the S100-B test, focusing on the negative predictive value and the negative likelihood ratio.

      Results

      CT scan revealed intracranial lesions in 111 (7%) participants, and their median S100-B protein plasma level was 0.46 μg/L (interquartile range [IQR] 0.27 to 0.72) versus 0.22 μg/L (IQR 0.14 to 0.36) in the other 1,449 patients. With a cutoff of 0.12 μg/L, traumatic brain injuries on CT were identified with a sensitivity of 99.1% (95% confidence interval [CI] 95.0% to 100%), a specificity of 19.7% (95% CI 17.7% to 21.9%), a negative predictive value of 99.7% (95% CI 98.1% to 100%), a positive likelihood ratio of 1.24 (95% CI 1.20 to 1.28), and a negative likelihood ratio of 0.04 (95% CI 0.006 to 0.32).

      Conclusion

      Measurement of plasma S100-B on admission of patients with minor head injury is a promising screening tool that may be of help to support the clinician's decision not to perform CT imaging in certain cases of low-risk head injury.
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      Linked Article

      • Utility of S100B in Head Injury Care
        Annals of Emergency MedicineVol. 61Issue 1
        • Preview
          Zongo et al1 suggest in their recent article that serum S100B has a high negative predictive value to rule out significant head injury in a large patient sample. Our previous work demonstrated that although there was an association between neuronal injury (acute stroke) and increases in S100B, there is clear evidence that hematopoietic cells were the main source of S100B in humans, not injured neurons.2 Other studies have cast doubt on the usefulness of S100B in human mild head injury as well.3
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