scholarly journals Serum S100B Determination in the Management of Pediatric Mild Traumatic Brain Injury

2012 ◽  
Vol 58 (7) ◽  
pp. 1116-1122 ◽  
Author(s):  
Damien Bouvier ◽  
Mathilde Fournier ◽  
Jean-Benoît Dauphin ◽  
Flore Amat ◽  
Sylvie Ughetto ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Reference Interval ◽  
Pediatric Emergency ◽  
Cranial Computed Tomography ◽  
Serum S100b ◽  
Significant Difference ◽  
Hospitalization Costs ◽  
Group 2

Abstract BACKGROUND The place of serum S100B measurement in mild traumatic brain injury (mTBI) management is still controversial. Our prospective study aimed to evaluate its utility in the largest child cohort described to date. METHODS Children younger than 16 years presenting at a pediatric emergency department within 3 h after TBI were enrolled prospectively for blood sampling to determine serum S100B concentrations. The following information was collected: TBI severity determined by using the Masters classification [1: minimal or Glasgow Coma Scale (GCS) 15, 2: mild or GCS 13–15, and 3: severe or GCS <13]; whether hospitalized or not; good or bad clinical evolution (CE); whether cranial computed tomography (CCT) was prescribed; and related presence (CCT+) or absence (CCT−) of lesions. RESULTS For the 446 children enrolled, the median concentrations of S100B were 0.21, 0.31, and 0.44 μg/L in Masters groups 1, 2, and 3, respectively, with a statistically significant difference between these groups (P < 0.05). In Masters group 2, 65 CCT scans were carried out. Measurement of S100B identified patients as CCT+ with 100% (95% CI 85–100) sensitivity and 33% (95% CI 20–50) specificity. Of the 424 children scored Masters 1 or 2, 21 presented “bad CE.” S100B identified bad CE patients with 100% (95% CI 84–100) sensitivity and 36% (95% CI 31–41) specificity. Of the 242 children hospitalized, 81 presented an S100B concentration within the reference interval. CONCLUSIONS Serum S100B determination during the first 3 h of management of children with mTBI has the potential to reduce the number of CCT scans, thereby avoiding unnecessary irradiation, and to save hospitalization costs.

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.

Analysis of Discourse Production to Assess Cognitive Communication Deficits Following Mild Traumatic Brain Injury With and Without Posttraumatic Stress

2021 ◽  
pp. 1-15
Author(s):  
Jennifer Rae Myers ◽  
Nancy Pearl Solomon ◽  
Rael T. Lange ◽  
Louis M. French ◽  
Sara M. Lippa ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Posttraumatic Stress ◽  
Mild Traumatic Brain Injury ◽  
Negative Emotion ◽  
Word Count ◽  
Discourse Production ◽  
Communication Deficits ◽  
Global Coherence ◽  
Significant Difference

Purpose: Cognitive communication deficits can be difficult to assess in individuals with mild traumatic brain injury (mTBI). However, the use of discourse analysis as a direct and sensitive metric of cognitive communication skills has shown promising clinical utility for other TBI severity levels. This exploratory study investigated discourse production in service members and veterans (SMVs) with uncomplicated mTBI with and without posttraumatic stress disorder (PTSD) and SMVs with neither mTBI or PTSD. Method: Fifteen SMVs with mTBI and PTSD, 26 with mTBI, and 25 controls with no brain injury (NBI) and without PTSD were given a wordless picture story to elicit spontaneous discourse. Discourse samples were analyzed for global coherence, word count, the use of negative emotion words, cognitive process words, nonfluencies, and story completeness. Results: Results revealed a significant difference between the mTBI ( Mdn = 3.33) and NBI ( Mdn = 3.50) groups, χ 2 (3) = 6.044, p = .017, ε 2 = .03, for global coherence. Word count differed significantly between the mTBI + PTSD ( Mdn = 135) and NBI ( Mdn = 195) groups, χ 2 (3) = 7.968, p = .006, ε 2 = .06. No other group differences were observed. Discussion: Structural features of discourse production may serve as potential markers of cognitive communication deficits in mTBI. Furthermore, PTSD may contribute to verbal fluency deficits in individuals with mTBI. Additional research is needed to develop discourse-related measures that are more sensitive to the effects of mTBI and PTSD.

scholarly journals Head CT overuse in children with a mild traumatic brain injury within two Canadian emergency departments

2019 ◽  
Vol 25 (1) ◽  
pp. 26-32
Author(s):  
Martin Gariepy ◽  
Jocelyn Gravel ◽  
France Légaré ◽  
Edward R Melnick ◽  
Erik P Hess ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Emergency Departments ◽  
Retrospective Chart Review ◽  
Trauma Centre ◽  
Diagnostic Tools ◽  
General Level ◽  
Head Ct ◽  
Significant Difference

Abstract Background The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs). Methods We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with head trauma. Simple descriptive statistics were applied. Results One thousand five hundred and forty-six eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%), respectively from sites 1 and 2 had a head CT performed. Based on the PECARN rule, we estimated the overuse for the younger group (&lt;2 years) to be below 3% for both hospitals without significant difference between them. For the older group (≥2 years), the overuse rate was higher at site 2 (9.3%, 95% confidence interval [CI]: 4.8 to 17% versus 1.2%, 95% CI: 0.2 to 6.5%, P=0.03). Conclusion Both EDs demonstrated overuse rates below 10% although it was higher for the older group at site 2. Such low rates can potentially be explained by the university affiliation of both hospitals and by two Canadian organizations working to raise awareness among physicians about the overuse of diagnostic tools and dangers inherent to radiation.

scholarly journals Assessment of the advantage of the serum S100B protein biomonitoring in the management of paediatric mild traumatic brain injury—PROS100B: protocol of a multicentre unblinded stepped wedge cluster randomised trial

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027365 ◽  
Author(s):  
Damien Bouvier ◽  
David Balayssac ◽  
Julie Durif ◽  
Charline Mourgues ◽  
Catherine Sarret ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Randomised Trial ◽  
S100b Protein ◽  
Cluster Randomised Trial ◽  
Control Group ◽  
Reference Ranges ◽  
Stepped Wedge ◽  
Serum S100b

IntroductionS100B serum analysis in clinical routine could reduce the number of cranial CT (CCT) scans performed on children with mild traumatic brain injury (mTBI). Sampling should take place within 3 hours of trauma and cut-off levels should be based on paediatric reference ranges. The aim of this study is to evaluate the utility of measuring serum S100B in the management of paediatric mTBI by demonstrating a decrease in the number of CCT scans prescribed in an S100B biomonitoring group compared with a ‘conventional management’ control group, with the assumption of a 30% relative decrease of the number of CCT scans between the two groups.Methods and analysisThe protocol is a randomised, multicentre, unblinded, prospective, interventional study (nine centres) using a stepped wedge cluster design, comparing two groups (S100B biomonitoring and control). Children in the control group will have CCT scans or be hospitalised according to the current recommendations of the French Society of Paediatrics (SFP). In the S100B biomonitoring group, blood sampling to determine serum S100B protein levels will take place within 3 hours after mTBI and subsequent management will depend on the assay. If S100B is in the normal range according to age, the children will be discharged from the emergency department after 6 hours’ observation. If the result is abnormal, CCT scans or hospitalisation will be prescribed in accordance with current SFP recommendations. The primary outcome measure will be the proportion of CCT scans performed (absence/presence of CCT scan for each patient) in the 48 hours following mTBI.Ethics and disseminationThe protocol presented (Version 5, 03 November 2017) has been approved by the ethics committee Comité de Protection des Personnes sud-est 6 (first approval 08 June 2016, IRB: 00008526). Participation in the study is voluntary and anonymous. The study findings will be disseminated in international peer-reviewed journals and presented at relevant conferences.Trial registration numberNCT02819778.

scholarly journals Psychometric validation of the revised child injury scale (Cries-13) in Greek population

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Kallianezos ◽  
M Bakola ◽  
K S Kitsou ◽  
C Petropoulos ◽  
X Sinopidis ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Psychometric Validation ◽  
Post Traumatic Stress ◽  
Significant Difference ◽  
Post Traumatic

Abstract Background Children and adolescents have an increased risk of post-traumatic stress following exposure to traumatic events. Thus, timely, valid and reliable assessment of the symptoms of the disorder is crucial. The purpose of the study was the psychometric validation of The Child Revised Impact of Events Scale (CRIES 13), following the preceding linguistic validation. Further goal was to evaluate post-traumatic stress disorder (PTSD) in children 6 to 14 years of age with mild traumatic brain injury (mTBI). Methods The questionnaire was consecutively administered to 175 parents coming to the Emergency Department of the Pediatric Hospital of Patras, after mTBI of their children. They were asked to respond one week and one month after the accident to assess PTSD of their children. For psychometric validation, exploratory (EFA) and confirmatory (CFA) factor analysis was performed. The questionnaire consists of 13 items rated on a non-linear scale ranging from 0 to 65, and higher scores indicate more PTSD symptoms with a threshold of 30. Results The Psychometric validation showed very good reliability (= 0.79) and EFA confirmed the factor structure of the original tool. In addition, CFA showed satisfactory fit for the three-factor model. Parents estimated post-traumatic stress one week after injury in 19% of the children. Statistically significant difference was observed only in monthly income, with parents of low income reporting higher levels of stress in their children (p = 0.046). Conclusions A reliable and valid questionnaire is now available in Greek for assessing the risk of PTSD in children. In one of five children presented in our hospital we observed a higher risk of developing post-traumatic stress one week after mild traumatic brain injury. Key messages There is reliable and valid questionnaire in Greek for assessing the risk of post-traumatic stress disorder in children.

scholarly journals S100B Serum Level as a Mortality Predictor for Traumatic Brain Injury: A Meta-Analysis

2018 ◽  
Vol 6 (11) ◽  
pp. 2239-2244 ◽  
Author(s):  
Nyoman Golden ◽  
Tjokorda Gde Bagus Mahadewa ◽  
Citra Aryanti ◽  
I Putu Eka Widyadharma
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Head Injuries ◽  
Case Series ◽  
Mortality Data ◽  
Serum S100b ◽  
Significant Difference ◽  
The Mean

  BACKGROUND: The pathogenesis of inflammatory neuronal cell damage will continue after traumatic brain injury in which contributed to subsequent mortality. Serum S100B levels were shown to be an early predictor of mortality due to traumatic brain injury. AIM: This Meta-Analysis will analyse the mean and diagnostic strength of serum S100B levels between survived and died subjects with head injuries based on the various follow-up times of nine studies. METHODS: We conducted a meta-anelysis in accordance with PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Literature search was conducted on March 16, 2018 from Medline and Scopus in the past 10 years, using various keywords related to S100, brain injury, and outcome. Duplicate journals were sorted out via EndNote. Included articles were as follows: original data from the group, clinical trials, case series, patients undergoing serum S100B levels with both short- and long-term follow-up mortality. Data were collected for mortality, serum S100B levels, and its diagnostic strength. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark). RESULTS: The results of the meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline (0.91, 95.9% CI 0.7-1.12, I2 = 98%, p < 0.001), during treatment (1.43, 95% CI 0.97 to 1.89, I2 = 98%, p < 0.001), or 6 months (0.19; 95%CI 0.1-0.29, I2 = 76%, p < 0.001) with an average threshold value that varies according to the study method used. The mean diagnostic strength was also promising to predict early mortality (sensitivity of 77.18% and 92.33%, specificity of 78.35% and 50.6%, respectively). CONCLUSION: S100B serum levels in the future will be potential biomarkers, and it is expected that there will be standardised guidelines for their application.

scholarly journals Reliability of serum S100B measurement following mild traumatic brain injury: a comparison of assay measurements from two laboratories

Brain Injury ◽  
2020 ◽  
Vol 34 (9) ◽  
pp. 1237-1244
Author(s):  
Grant L. Iverson ◽  
Jussi P. Posti ◽  
Juha Öhman ◽  
Kaj Blennow ◽  
Henrik Zetterberg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Serum S100b

scholarly journals 361 The relationship between intracranial MRI abnormalities and post-concussive symptoms in ED patients with a normal CT: as demonstrated on the Rivermead Post Concussion Symptom Questionnaire (RPQ)

2020 ◽  
Vol 37 (12) ◽  
pp. 842.2-842
Author(s):  
Daniel Whitehouse ◽  
Sophie Richter ◽  
Stefan Winzeck ◽  
Evgenios N Kornaropoulos ◽  
Tilak Das ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Diffuse Axonal Injury ◽  
Quantitative Mri ◽  
List Type ◽  
Mri Findings ◽  
Number Of Patients ◽  
Significant Difference ◽  
Prospective Longitudinal

Aims/Objectives/BackgroundMild traumatic brain injury (TBI) is common presentation to the ED. Mild, however, is a misnomer with 10–40% of patients suffering from post-concussion symptoms for months to years following injury.1 2Patients often re-present to primary care or ED with these symptoms, and the role of repeat imaging in this cohort remains uncertain. Aims: assess TBI patients discharged from the ED with no acute intracranial findings on CT head scan, who subsequently had a research-driven MRI and documented 3-month RPQ, to determine the association between ongoing post-concussion symptoms and MRI pathology.Methods/Design91 patients in the CENTER-TBI dataset met the inclusion criteria.3 Mann-Whitney U test used to compare 3-month RPQ and MRI findings. Numbers and percentages of patients with RPQ >35 and >19 presented owing to a score of 35 predicting moderate to severe activity limitation,4 and 19 representing mean RPQ in patients with diagnosed post-concussion syndrome (PCS).2Results/Conclusions15/91 CT-ve (16.5%) patients had abnormalities on acute MRI (2 intraparenchymal haemorrhages, 13 Diffuse Axonal Injury (DAI)). No significant difference between median 3 month RPQ between MRI -ve (2.00 [IQR 0.00 – 14.00] and MRI +ve (0.00 [IQR 0.00 – 8.50]) patients (p=0.51, Mann-Whitney U test). Of patients with a RPQ >35, only 1/8 (12.5%) had a +ve MRI. Of patients with a RPQ >19 2/14 (14.3%) had +ve MRI, both DAI.No difference was found between RPQ scores of MRI positive and negative patients, suggesting no significant relationship between ongoing symptomology following mild TBI and gross MRI findings in patients with a negative acute CT. This study is limited by a small number of patients with positive neuroimaging and a lack of quantitative MRI data. Further prospective research is required to assessing a larger patient cohort and more sensitive imaging modalities to examine the utility of repeat neuroimaging in patients with ongoing concussive symptoms.ReferencesPolinder S, Cnossen MC, Real RGL, et al. A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Front. Neurol 2018;9:1113. doi:10.3389/fneur.2018.01113Ingebrigtsen T, Waterloo K, Marup-Jensen S, et al. Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients. J Neurol 1998;245:609–12. doi:10.1007/s004150050254Maas AIR, Menon DK, Steyerberg EW, et al. Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): A prospective longitudinal observational study. Neurosurgery 2015;76:67–80. doi:10.1227/NEU.0000000000000575De Guise E, Bélanger S, Tinawi S, et al. Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury. Appl Neuropsychol 2016;23:213–22. doi:10.1080/23279095.2015.1038747

scholarly journals S100β protein levels as a parameter to assess the clinical development of adult patients with mild traumatic brain injury in Dr. Moewardi Public Hospital, Surakarta

2021 ◽  
Vol 12 ◽  
pp. 342
Author(s):  
Ferry Wijanarko ◽  
Untung Alifianto ◽  
Hanis Setyono ◽  
Geizar Arsika Ramadhana ◽  
Affan Adib Sungkar ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Public Hospital ◽  
Clinical Development ◽  
Adult Patients ◽  
Protein Levels ◽  
S100β Protein ◽  
Significant Difference

Background: Mild traumatic brain injury (mTBI) is a health problem with an increasing incidence in many developed countries. The standard for examining mTBI is a CT scan, but it is costly, is not always available in all hospitals, and carries a risk of radiation. Meanwhile, S100β is a protein component produced by central nervous system cells. This study aims to determine the presence of changes in S100β protein in adult patients with mTBI during treatment as an alternative to examination. Methods: This research is an analytic observational quantitative study with a cross-sectional study approach to investigate changes in S100β protein levels in blood serum using the ELISA method of mTBI patients in the first 3 h posttrauma (pretest) and treatment on day 1 (27 h posttrauma/posttest). The research sample consisted of 22 people. This research was conducted in the Surgery Section, Sub-Division of Neurosurgery, Dr. Moewardi Public Hospital, during September–December 2019. The data were then analyzed using a discrimination test (comparing t-test means) and a nonparametric test (Wilcoxon). Results: There was a significant difference in mean S100β change between the pretest and posttest treatments. The S100β examination results at posttest decreased to 0.0223 + 0.0029 μg/l or decreased S100β by 21.7% after treatment. Previously, it was known that the mean of S100β at pretest was 0.0285 + 0.0137 μg/l. Conclusion: There was a significant change in S100β protein levels at each examination time. Changes in S100β levels that occurred were in the form of decreased levels from 3 h to 27 h posttrauma. Thus, S100β protein can be used as a parameter to assess the clinical development of adult patients with mTBI. Moreover, none of the patients with an S100β value >0.1 μg/l was found to be the cutoff value set by SNC in adult patients with mTBI for head CT scan.

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