Karamian Armin, Farzaneh Hana, Khoshnoodi Masoud, Maleki Nazanin, Karamian Amin, Stufflebeam Steven, Lucke-Wold Brandon
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Radiology (Neuroradiology) at Massachusetts General Hospital, Boston, MA, USA.
Neurocrit Care. 2025 Jan 7. doi: 10.1007/s12028-024-02189-7.
Traumatic brain injury (TBI) is a major cause of health loss and disabilities globally, burdening health care systems. Mild TBI is a common cause of emergency department visits. Computed tomography (CT) scans are the mainstay for acute TBI imaging. S100 calcium-binding protein B (S100B) biomarker is promising for predicting intracranial lesions on CTs in mild TBI. A comprehensive search of the literature was conducted on PubMed, Google Scholar, and Cochrane electronic databases to find eligible studies reporting the diagnostic performance of S100B. A meta-analysis was conducted to evaluate the predictive ability of S100B for CT imaging abnormalities. Of 1545 articles, 32 were included in our meta-analysis. At the threshold of 0.1 μg/L, a bivariate model showed a sensitivity of 89% (95% confidence interval [CI] 83-92) with a specificity of 32% (95% CI 26-39). The aggregate analysis containing all cutoffs showed the optimal cutoff of 0.751 μg/L with a sensitivity of 64% (95% CI 32-87) and a specificity of 85% (95% CI 76-92). The optimal diagnostic performance of S100B in patients with Glasgow Coma Scale 14-15 was estimated to be 0.05 μg/L, with a sensitivity of 98% (95% CI 92-99) and a negative predictive value of 99%. These findings indicate that S100B analysis could minimize the need for unnecessary CT scans in individuals with mild TBI. The test's diagnostic accuracy improves when the S100B analysis is done within 3 h of the injury. However, further research is warranted to validate its superiority to other biomarkers before considering it the standard routine for managing mild TBI.
创伤性脑损伤（TBI）是全球范围内导致健康损失和残疾的主要原因，给医疗保健系统带来了沉重负担。轻度TBI是急诊科就诊的常见原因。计算机断层扫描（CT）是急性TBI成像的主要手段。S100钙结合蛋白B（S100B）生物标志物有望用于预测轻度TBI患者CT上的颅内病变。我们在PubMed、谷歌学术和考克兰电子数据库中全面检索文献，以查找报告S100B诊断性能的合格研究。进行了一项荟萃分析，以评估S100B对CT成像异常的预测能力。在1545篇文章中，有32篇纳入了我们的荟萃分析。在阈值为0.1μg/L时，二元模型显示灵敏度为89%（95%置信区间[CI]83 - 92），特异性为32%（95%CI 26 - 39）。包含所有临界值的综合分析显示，最佳临界值为0.751μg/L，灵敏度为64%（95%CI 32 - 87），特异性为85%（95%CI 76 - 92）。格拉斯哥昏迷量表评分为14 - 15分的患者中，S100B的最佳诊断性能估计为0.05μg/L，灵敏度为98%（95%CI 92 - 99），阴性预测值为99%。这些发现表明，S100B分析可减少轻度TBI患者不必要的CT扫描需求。在受伤后3小时内进行S100B分析时，该检测的诊断准确性会提高。然而，在将其视为管理轻度TBI的标准常规方法之前，有必要进行进一步研究以验证其相对于其他生物标志物的优越性。
