1 Department of Emergency Medicine, Universitry of Rochester School of Medicine and Dentistry , Rochester, New York.
J Neurotrauma. 2013 Oct 15;30(20):1747-54. doi: 10.1089/neu.2013.2853. Epub 2013 Aug 24.
The objective of the current study was to determine the classification accuracy of serum S100B and apolipoprotein (apoA-I) for mild traumatic brain injury (mTBI) and abnormal initial head computed tomography (CT) scan, and to identify ethnic, racial, age, and sex variation in classification accuracy. We performed a prospective, multi-centered study of 787 patients with mTBI who presented to the emergency department within 6 h of injury and 467 controls who presented to the outpatient laboratory for routine blood work. Serum was analyzed for S100B and apoA-I. The outcomes were disease status (mTBI or control) and initial head CT scan. At cutoff values defined by 90% of controls, the specificity for mTBI using S100B (0.899 [95% confidence interval (CI): 0.78-0.92]) was similar to that using apoA-I (0.902 [0.87-0.93]), and the sensitivity using S100B (0.252 [0.22-0.28]) was similar to that using apoA-I (0.249 [0.22-0.28]). The area under the receiver operating characteristic curve (AUC) for the combination of S100B and apoA-I (0.738, 95% CI: 0.71, 0.77), however, was significantly higher than the AUC for S100B alone (0.709, 95% CI: 0.68, 0.74, p=0.001) and higher than the AUC for apoA-I alone (0.645, 95% CI: 0.61, 0.68, p<0.0001). The AUC for prediction of abnormal initial head CT scan using S100B was 0.694 (95%CI: 0.62, 0.77) and not significant for apoA-I. At a S100B cutoff of <0.060 μg/L, the sensitivity for abnormal head CT was 98%, and 22.9% of CT scans could have been avoided. There was significant age and race-related variation in the accuracy of S100B for the diagnosis of mTBI. The combined use of serum S100B and apoA-I maximizes classification accuracy for mTBI, but only S100B is needed to classify abnormal head CT scan. Because of significant subgroup variation in classification accuracy, age and race need to be considered when using S100B to classify subjects for mTBI.
本研究的目的是确定血清 S100B 和载脂蛋白（apoA-I）对轻度创伤性脑损伤（mTBI）和异常初始头部计算机断层扫描（CT）的分类准确性，并确定分类准确性的种族、种族、年龄和性别差异。我们对 787 名 mTBI 患者进行了前瞻性、多中心研究，这些患者在受伤后 6 小时内到急诊科就诊，对 467 名在门诊实验室进行常规血液检查的对照者进行了前瞻性、多中心研究。对血清进行了 S100B 和 apoA-I 分析。结果是疾病状态（mTBI 或对照）和初始头部 CT 扫描。在对照组的 90%定义的截止值下，使用 S100B（0.899 [95%置信区间（CI）：0.78-0.92]）的 mTBI 的特异性与使用 apoA-I（0.902 [0.87-0.93]）相似，而使用 S100B（0.252 [0.22-0.28]）的敏感性与使用 apoA-I（0.249 [0.22-0.28]）相似。然而，S100B 和 apoA-I 联合的受试者工作特征曲线（ROC）下面积（AUC）（0.738，95%CI：0.71，0.77）明显高于单独使用 S100B 的 AUC（0.709，95%CI：0.68，0.74，p=0.001），也高于单独使用 apoA-I 的 AUC（0.645，95%CI：0.61，0.68，p<0.0001）。使用 S100B 预测异常初始头部 CT 扫描的 AUC 为 0.694（95%CI：0.62，0.77），而 apoA-I 则无统计学意义。S100B 截止值<0.060 μg/L 时，头部 CT 异常的敏感性为 98%，可避免 22.9%的 CT 扫描。S100B 对 mTBI 的诊断准确性存在显著的年龄和种族相关差异。血清 S100B 和 apoA-I 的联合使用可最大程度地提高 mTBI 的分类准确性，但仅使用 S100B 即可对异常头部 CT 进行分类。由于分类准确性存在显著的亚组差异，在使用 S100B 对 mTBI 患者进行分类时，需要考虑年龄和种族因素。
