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KMID : 0385920080190030303
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Journal of the Korean Society of Emergency Medicine
2008 Volume.19 No. 3 p.303 ~ p.312
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The Effect of S-100B Protein and Risk Factors on Indication of Cranial Computed Tomography in Patients with Minor Head Injury
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Ahn Seung-Chan
Ryu Seok-Yong
Cho Suk-Jin
Lee Sang-Lae
Oh Sung-Chan
Kim Hong-Yong
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Abstract
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Purpose: S-100B protein is a reliable biomarker of brain injury. The clinical decision rules for screening of a cranial computed tomography (CCT) in minor head injury patients remain controversial. The purpose of this study was to
determine whether S-100B protein and risk factors for minor head injury patients can provide meaningful insights to improve initial CCT scanning of patients with MHI.
Methods: Fifty patients with MHI were enrolled in this prospective study from July 2007 to September 2007. All
patients who fulfilled the following inclusion criteria were enrolled: history of head trauma, initial GCS score of 14 to
15, and one or more clinical findings. Risk factors of patients presented in this study included age younger than 2 years or above sixty years, focal neurologic deficit (FND), post-traumatic seizure, skull fracture, extra-cranial injury, coagulopathy, previous neurologic deficit and ingestion of toxicants (drugs or alcohol). A venous blood sample for assessment of S-100B protein was drawn and a CCT scan was undergone. The reference value of S-100B protein was 0.105 μg/L. All CCT findings were confirmed by radiologists.
Results: Of the 50 patients studied, 15 patients exhibited trauma-relevant intracranial lesions on the CCT scan (CCTpositive). The subgroups of CCT-positive and -negative showed no statistically difference in S-100B level (p=0.068).
Of the fifty patients, thirteen had no risk factors (RF). However, statistically significant differences were observed in S-100B level when the subgroups were classified into RF-positive and RF-negative groups (p=0.016). The CCTpositive findings of 13 patients with no RF were identified with 100% sensitivity, 54.6% specificity, 28.6% positive predictive value and 100% negative predictive value through assessment of S-100B protein level.
Conclusion: In patients with MHI, S-100B protein level and risk factors may give us reliable predictive information prior to CCT screening in emergency department.
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KEYWORD
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S-100B protein, Risk factors, Cranial computed tomography, Minor head injury
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