S100B serum level predicts computed tomography findings after minor head injury
S100B serum level predicts computed tomography findings after minor head injury
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DOI：
10.1097/ta.0b013e318047bfaa
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发表时间：
2007-06-01
影响因子：
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通讯作者：
Ingebrigtsen, Tor
中科院分区：
文献类型：
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作者：
Muller, Kay;Townend, Will;Ingebrigtsen, Tor
背景：轻度头部损伤(MHI)意味着创伤性脑损伤的风险，甚至有发生颅内血肿的微小风险。头部计算机断层扫描(CT)被推荐用于此类病理发现的早期检测。本多中心研究旨在探讨血清S100B蛋白测定是否有助于CT扫描患者的选择。方法：226例患者入院时有颅脑损伤史，格拉斯哥昏迷评分(GCS)13~15分。伤后12小时内采集血样进行S100B分析和头颅CT检查。采用受试者工作特性(ROC)分析和不同截断点水平的交叉表分析，检验S100B测量对CT显示的颅脑损伤的诊断价值。结果：21例(9.3%)患者CT显示颅脑损伤。有颅脑损伤组S100B水平(平均值0.36，95%CI，0.21~0.50u g/L)显著高于非颅脑损伤组(平均值0.18，95%CI，0.16~0.20u g/L)。ROC曲线分析显示曲线下面积显著(p=0.001)(0.73；95%可信区间0.62~0.84)。交叉表分析显示，21例颅内损伤患者中有20例(敏感性为0.95)以0.10微克/L为临界值，而205例无颅内损伤患者中有141例(特异性为0.31)S100B水平也高于这一界限。结论：血清S100B测定不能替代临床检查或CT的使用，但在临床评价中加入S100B测定可能有助于CT扫描患者的选择。
Background: Mild head injury (MHI) implies a risk for traumatic brain injury and even a small risk for development of an intracranial hematoma. Head computed tomography (CT) is recommended for early detection of such pathologic findings. The present multicenter study was performed to investigate whether determination of protein S100B in serum could contribute to the selection of patients for CT scanning.Methods: We included 226 patients with a history of head injury and a Glasgow Coma Scale (GCS) score of 13 to 15 at admission to hospital. Blood samples for S100B analysis and head CT were obtained within 12 hours after the injury. The diagnostic properties of S100B measurements for prediction of intracranial injury revealed by CT were tested with receiver operating characteristic (ROC) analysis and cross-table analysis at different cut-off levels. We also included analysis of S100B levels normalized to correspond to blood sampling I hour after the injury.Results: CT showed intracranial injury in 21 (9.3%) patients. S100B levels were significantly (p < 0.001) elevated in patients with intracranial injury (mean, 0.36; 95% CI, 0.21-0.50 mu g/L) compared with those in patients without intracranial injury (mean, 0.18; 95% CI, 0.16-0.20 mu g/L). ROC curve analysis showed a significant (p = 0.001) area under the curve (0.73; 95% CI, 0.62-0.84). Cross-table analysis showed that 20 of 21 (sensitivity 0.95) patients with intracranial injury were detected at a cut-off level of 0.10 mu g/L, but 141 of 205 (specificity 0.31) patients with no such injury also had a S100B level above this limit. Exclusion of cases with blood samples collected more than 3 hours after injury or normalization did not improve the diagnostic properties.Conclusion: Determination of serum S100B cannot replace the clinical examination or use of CT for patients with minor head injury, but adding S100B measurement to the clinical evaluation might support selection of patients for CT scanning.