scholarly journals Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention

2012 ◽  
Vol 72 (5) ◽  
pp. 1335-1344 ◽  
Author(s):  
Linda Papa ◽  
Lawrence M. Lewis ◽  
Salvatore Silvestri ◽  
Jay L. Falk ◽  
Philip Giordano ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Serum Levels ◽  
Moderate Traumatic Brain Injury ◽  
Intracranial Lesions ◽  
Neurosurgical Intervention

scholarly journals Neurosurgical intervention in patients with mild traumatic brain injury and its effect on neurological outcomes

2016 ◽  
Vol 124 (2) ◽  
pp. 538-545 ◽  
Author(s):  
Kevin James Tierney ◽  
Natasha V. Nayak ◽  
Charles J. Prestigiacomo ◽  
Ziad C. Sifri
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Nonoperative Management ◽  
Intervention Group ◽  
Clinical Predictors ◽  
Neurological Outcomes ◽  
Cranial Ct ◽  
Delayed Intervention ◽  
Neurosurgical Intervention

OBJECT The object of this study was to determine the mortality and neurological outcome of patients with mild traumatic brain injury (mTBI) who require neurosurgical intervention (NSI), identify clinical predictors of a poor outcome, and investigate the effect of failed nonoperative management and delayed NSI on outcome. METHODS A cross-sectional study of 10 years was performed, capturing all adults with mTBI and NSI. Primary outcome variables were mortality and Glasgow Outcome Scale (GOS) score. Patients were divided into an immediate intervention group, which received an NSI after the initial cranial CT scan, and a delayed intervention group, which had failed nonoperative management and received an NSI after 2 or more cranial CT scans. RESULTS The mortality rate in mTBI patients requiring NSI was 13%, and the mean GOS score was 3.6 ± 1.2. An age > 60 years was independently predictive of a worse outcome, and epidural hematoma was independently predictive of a good outcome. Logistic regression analysis using independent variables was calculated to create a model for predicting poor neurological outcomes in patients with mTBI undergoing NSI and had 74.1% accuracy. Patients in the delayed intervention group had worse mortality (25% vs 9%) and worse mean GOS scores (2.9 ± 1.3 vs 3.7 ± 1.2) than those in the immediate intervention group. CONCLUSIONS Data in this study demonstrate that patients with mTBI requiring NSI have higher mortality rates and worse neurological outcomes and should therefore be classified separately from mTBI patients not requiring NSI. Additionally, mTBI patients requiring NSI after the failure of nonoperative management have worse outcomes than those receiving immediate intervention and should be considered separately.

scholarly journals Diagnostic accuracy of prehospital serum S100B and GFAP in patients with mild traumatic brain injury: a prospective observational multicenter cohort study – “the PreTBI I study”

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Sophie-Charlott Seidenfaden ◽  
Julie Linding Kjerulff ◽  
Niels Juul ◽  
Hans Kirkegaard ◽  
Mette Fogh Møller ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diagnostic Accuracy ◽  
Mild Traumatic Brain Injury ◽  
Calcium Binding ◽  
Adult Patients ◽  
Index Test ◽  
Intracranial Lesion ◽  
Intracranial Lesions ◽  
Rule Out

Abstract Background The biomarker serum S100 calcium-binding protein B (S100B) is used in in-hospital triage of adults with mild traumatic brain injury to rule out intracranial lesions. The biomarker glial fibrillary acidic protein (GFAP) is suggested as a potential diagnostic biomarker for traumatic brain injury. The aim of this study was to investigate the diagnostic accuracy of early prehospital S100B and GFAP measurements to rule out intracranial lesions in adult patients with mild traumatic brain injury. Methods Prehospital and in-hospital blood samples were drawn from 566 adult patients with mild traumatic brain injury (Glasgow Coma Scale Score 14–15). The index test was S100B and GFAP concentrations. The reference standard was endpoint adjudication of the traumatic intracranial lesion based on medical records. The primary outcome was prehospital sensitivity of S100B in relation to the traumatic intracranial lesion. Results Traumatic intracranial lesions were found in 32/566 (5.6%) patients. The sensitivity of S100B > 0.10 μg/L was 100% (95%CI: 89.1;100.0) in prehospital samples and 100% (95% CI 89.1;100.0) in in-hospital samples. The specificity was 15.4% (95%CI: 12.4;18.7) in prehospital samples and 31.5% (27.5;35.6) in in-hospital samples. GFAP was only detected in less than 2% of cases with the assay used. Conclusion Early prehospital and in-hospital S100B levels < 0.10 μg/L safely rules out traumatic intracranial lesions in adult patients with mild traumatic brain injury, but specificity is lower with early prehospital sampling than with in-hospital sampling. The very limited cases with values detectable with our assay do not allow conclusions to be draw regarding the diagnostic accuracy of GFAP. Trial registration ClinicalTrials.gov identifier: NCT02867137.

Clinical validation of S100B in the management of a mild traumatic brain injury: issues from an interventional cohort of 1449 adult patients

2018 ◽  
Vol 56 (11) ◽  
pp. 1897-1904 ◽  
Author(s):  
Gautier Allouchery ◽  
Farès Moustafa ◽  
Jean Roubin ◽  
Bruno Pereira ◽  
Jeannot Schmidt ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Serum Levels ◽  
Primary Objective ◽  
Cranial Computed Tomography ◽  
Significant Difference ◽  
Medium Risk ◽  
Associated Risk Factors ◽  
A Prospective Study

Abstract Background: 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. Methods: 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. Results: 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). Conclusions: 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.

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