University Hospital, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France.
Clermont Auvergne University, CNRS 6293, INSERM 1103, GReD, Clermont-Ferrand, France.
J Gerontol A Biol Sci Med Sci. 2021 Jul 13;76(8):1471-1479. doi: 10.1093/gerona/glab055.
We previously assessed the inclusion of S100B blood determination into clinical decision rules for mild traumatic brain injury (mTBI) management in the Emergency Department (ED) of Clermont-Ferrand Hospital. At the 0.10 µg/L threshold, S100B reduced the use of cranial computed tomography (CCT) scan in adults by at least 30% with a ~100% sensitivity. Older patients had higher serum S100B values, resulting in lower specificity (18.7%) and decreased CCT reduction. We conducted this study to confirm the age effect on S100B concentrations, and to propose new decisional thresholds for older patients.
A total of 1172 mTBI patients aged 65 and over were included. They were divided into 3 age groups: 65-79, 80-89, and ≥ 90 years old. S100B's performance to identify intracranial lesions (sensitivity [SE] and specificity [SP]) was assessed using the routine 0.10 µg/L threshold and also other more efficient thresholds established for each age group.
S100B concentration medians were 0.18, 0.26, and 0.32 µg/L for the 65-79, 80-89, and ≥ 90 years old age groups, respectively (p < .001). The most efficient thresholds were 0.11 µg/L for the 65-79 age group and 0.15 µg/L for the other groups. At these new thresholds, SP was respectively 28.4%, 34.3%, and 20.5% for each age group versus 24.9%, 18.2%, and 10.5% at the 0.10 µg/L threshold.
Adjustment of the S100B threshold is necessary in older patients' management. An increased threshold of 0.15 µg/L is particularly interesting for patients ≥ 80 years old, allowing a significant increase of CCT scan reduction (29.3%).
我们之前评估了 S100B 血液测定在克莱蒙费朗医院急诊科（ED）管理轻度创伤性脑损伤（mTBI）的临床决策规则中的纳入情况。在 0.10μg/L 阈值下，S100B 使成年人的头颅计算机断层扫描（CCT）使用率降低了至少 30%，而敏感性约为 100%。老年患者的血清 S100B 值较高，导致特异性（18.7%）降低，CCT 减少。我们进行这项研究是为了确认年龄对 S100B 浓度的影响，并为老年患者提出新的决策阈值。
共纳入 1172 名 65 岁及以上的 mTBI 患者。他们被分为 3 个年龄组：65-79 岁、80-89 岁和≥90 岁。使用常规的 0.10μg/L 阈值和为每个年龄组确定的其他更有效的阈值评估 S100B 识别颅内病变的性能（敏感性 [SE] 和特异性 [SP]）。
65-79 岁、80-89 岁和≥90 岁年龄组的 S100B 浓度中位数分别为 0.18、0.26 和 0.32μg/L（p<.001）。最有效的阈值分别为 0.11μg/L 用于 65-79 岁年龄组和 0.15μg/L 用于其他组。在这些新的阈值下，SP 分别为 28.4%、34.3%和 20.5%，每个年龄组分别为 0.10μg/L 阈值的 24.9%、18.2%和 10.5%。
需要调整老年患者管理中的 S100B 阈值。对于≥80 岁的患者，将阈值增加到 0.15μg/L 特别有趣，这可以显著增加 CCT 扫描减少量（29.3%）。
