Clinical validation of S100B in the management of a mild traumatic brain injury: issues from an interventional cohort of 1449 adult patients
Clinical validation of S100B in the management of a mild traumatic brain injury: issues from an interventional cohort of 1449 adult patients
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DOI：
10.1515/cclm-2018-0471
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发表时间：
2018-11-01
影响因子：
6.8
通讯作者：
Bouvier, Damien
中科院分区：
文献类型：
--
作者：
Allouchery, Gautier;Moustafa, Fares;Bouvier, Damien
背景：本研究的主要目的是通过前瞻性研究验证S100 B的常规使用。目的是减少30%的头颅计算机断层扫描（CCT）扫描。次要目标是调查年龄和相关危险因素对减少CCT.Methods的影响：S100 B（3小时内采样伤后）被用于轻度创伤性脑损伤（mTBIs）的患者提出了中等风险的并发症，需要CCT扫描。S100 B阴性（S100 B-）患者出院时未进行CCT扫描。32.3%的患者有S100 B-，敏感性为96.4%，特异性为33.4%（95%CI：31%-36%），阴性预测值为99.6%（95%CI：98.5%-99.9%）。如果患者有逆行性遗忘（0.16 μ g/L; 63.8%）、意识丧失（0.13; 63.6%）或抗血小板治疗（0.20; 77.9%），则未观察到血清水平或S100 B+率的显著差异。年龄> 65岁组与年龄< 55岁组（18-25岁、26-35岁、36-45岁、46-55岁）比较，血清S100 B浓度及阳性率差异有统计学意义（P <0.05）。18 ~ 65岁（n = 874），特异性为39.3%（95% CI：36%-42.6%）与18.7%相比（95%CI：15.3%-22.3%）。结论：临床使用S100 B治疗mTBI可减少约三分之一的CCT使用;此外，CCT减少的百分比受患者年龄的影响。
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 mu g/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.