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The objective of the current study was to determine the classification accuracy of serum S100B and apolipoprotein (apoA-I) for mild traumatic brain injury (mTBI) and abnormal initial head computed tomography (CT) scan, and to identify ethnic, racial, age, and sex variation in classification accuracy. We performed a prospective, multi-centered study of 787 patients with mTBI who presented to the emergency department within 6 h of injury and 467 controls who presented to the outpatient laboratory for routine blood work. Serum was analyzed for S100B and apoA-I. The outcomes were disease status (mTBI or control) and initial head CT scan. At cutoff values defined by 90% of controls, the specificity for mTBI using S100B (0.899 [95% confidence interval (CI): 0.78-0.92]) was similar to that using apoA-I (0.902 [0.87-0.93]), and the sensitivity using S100B (0.252 [0.22-0.28]) was similar to that using apoA-I (0.249 [0.22-0.28]). The area under the receiver operating characteristic curve (AUC) for the combination of S100B and apoA-I (0.738, 95% CI: 0.71, 0.77), however, was significantly higher than the AUC for S100B alone (0.709, 95% CI: 0.68, 0.74, p = 0.001) and higher than the AUC for apoA-I alone (0.645, 95% CI: 0.61, 0.68, p < 0.0001). The AUC for prediction of abnormal initial head CT scan using S100B was 0.694 (95%CI: 0.62, 0.77) and not significant for apoA-I. At a S100B cutoff of < 0.060 lg/L, the sensitivity for abnormal head CT was 98%, and 22.9% of CT scans could have been avoided. There was significant age and race-related variation in the accuracy of S100B for the diagnosis of mTBI. The combined use of serum S100B and apoA-I maximizes classification accuracy for mTBI, but only S100B is needed to classify abnormal head CT scan. Because of significant subgroup variation in classification accuracy, age and race need to be considered when using S100B to classify subjects for mTBI.

To survey the attitudes of healthcare personnel regarding influenza immunization. DESIGN: A questionnaire was given to all hospital employees. SETTING: A 650-bed community teaching hospital. INTERVENTION: Employees were offered an in-service regarding influenza immunization in October 1991. Influenza immunization was given free of charge by Employee Health Services from October to December 1991. One thousand fiftysix employees (30.2%) received influenza vaccines. Survey forms were distributed with paychecks to all employees during the second half of January 1992. Completed survey forms were returned during the next 2 weeks. RESULTS: One thousand two hundred three of the 3,501 (34.3%) questionnaires were returned. Some of the survey forms were not completely filled out. A total of 28.1% of male employees (202/717) and 35.4% of female employees (987/2783) (p<.01) responded. Mean years employed were 11.35 ± 7.57 for respondents and 9.30 ± 7.39 for all employees (p<.OOl). Four hundred sixty-one respondents (38.4%) received the influenza vaccine and 734 (6 1.4%) did not. Among the respondents, employees who were older or working full time were more likely to receive the vaccine. Proportionally, more respondents who received the vaccine attended the in-service, although only 8.7% of those immunized attributed their receiving influenza vaccine to the in-service. More physician respondents were vaccinated. Tbe respondents who received influenza vaccine were more likely to have received the vaccine during the past 2 years (p<.001). The major reasons given for not receiving the vaccine were "bad side effects" and "do not like shots." The major side effect of influenza immunization was a "sore arm." Multivariate analysis suggested that the in-service was not associated with obtaining the vaccine. CONCLUSIONS: The in-service regarding influenza immunization seemed to have a negligible influence. Most employees who received the vaccine had previous influenza immunization. There were no major side effects of influenza immunization. "Bad side effects" and "do not like shots" were major reasons given for not receiving influenza vaccine.