CHU Clermont-Ferrand, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France.
CHU Clermont-Ferrand, Adult Emergency Department, Clermont-Ferrand, France.
Clin Chem Lab Med. 2018 Oct 25;56(11):1897-1904. doi: 10.1515/cclm-2018-0471.
This study's primary objective was to validate the routine use of S100B via a prospective study. The aim was a reduction of cranial computed tomography (CCT) scans by 30%. The secondary goal was to investigate the influence of age and associated risk factors on the reduction of CCT.
S100B (sampling within 3 h postinjury) was used for patients with mild traumatic brain injury (mTBIs) presenting a medium risk of complications and requiring a CCT scan. Patients with negative S100B (S100B-) were discharged without a CCT scan.
Of the 1449 patients included in this study, 468 (32.3%) had S100B- with a sensitivity of 96.4% (95% CI: 87.5%-99.6%), a specificity of 33.4% (95% CI: 31%-36%) and a negative predictive value of 99.6% (95% CI: 98.5%-99.9%). No significant difference in serum levels or the S100B+ rate was observed if patients had retrograde amnesia (0.16 μg/L; 63.8%), loss of consciousness (0.13; 63.6%) or antiplatelet therapy (0.20; 77.9%). Significant differences were found between the S100B concentrations and S100B positivity rates in patients >65 years old and all the groups with patients <55 years old (18-25, 26-35, 36-45 and 46-55). From 18 to 65 years old (n=874), the specificity is 39.3% (95% CI: 36%-42.6%) compared to 18.7% (95% CI: 15.3%-22.3%) for patients >65 years old (n=504).
The clinical use of S100B in mTBI management reduces the use of CCTs by approximately one-third; furthermore, the percentage of CCTs reduction is influenced by the age of the patient.
本研究的主要目的是通过前瞻性研究验证 S100B 的常规应用。目标是将头颅计算机断层扫描（CCT）的数量减少 30%。次要目标是研究年龄和相关危险因素对 CCT 减少的影响。
对存在中等并发症风险且需要进行 CCT 扫描的轻度创伤性脑损伤（mTBI）患者，使用 S100B（损伤后 3 小时内采样）。S100B 阴性（S100B-）的患者无需进行 CCT 扫描即可出院。
在这项研究中，纳入了 1449 名患者，其中 468 名（32.3%）患者的 S100B-，其灵敏度为 96.4%（95%CI：87.5%-99.6%），特异性为 33.4%（95%CI：31%-36%），阴性预测值为 99.6%（95%CI：98.5%-99.9%）。有逆行性遗忘（0.16μg/L；63.8%）、意识丧失（0.13；63.6%）或抗血小板治疗（0.20；77.9%）的患者，其血清水平或 S100B+率无显著差异。>65 岁的患者和所有<55 岁的患者（18-25 岁、26-35 岁、36-45 岁和 46-55 岁）的 S100B 浓度和 S100B 阳性率之间存在显著差异。18-65 岁的患者（n=874）的特异性为 39.3%（95%CI：36%-42.6%），而>65 岁的患者（n=504）的特异性为 18.7%（95%CI：15.3%-22.3%）。
S100B 在 mTBI 管理中的临床应用可使 CCT 的使用量减少约三分之一；此外，CCT 减少的百分比受患者年龄的影响。
