A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

Vedin, Tomas; Karlsson, Mathias; Edelhamre, Marcus; Clausen, Linus; Svensson, Sebastian; Bergenheim, Mikael; Larsson, Per Anders

doi:10.1007/s00068-019-01145-x

Cited by 8 publications

(13 citation statements)

References 49 publications

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“…Subsequently, a small but not negligible number of patients experience long-term disability or die due to intracranial complications. As the outcome depends on timely diagnosis and appropriate treatment of intracranial lesions [ 10 , 11 ], several guidelines have been developed to identify patients that can safely be discharged from those with a need for a CCT scan as the reference diagnostic tool [ 4 , 5 , [12] , [13] , [14] , [15] , [16] ].…”

Section: Introductionmentioning

confidence: 99%

“…Its short half-life time of 60–120 min restricts the analysis to patients presenting within 6 h after injury [ 4 , 23 ]. Due to its high negative predictive value (NPV) of 99% for normal CCT findings [ 17 ], it has been included into few guidelines as pre-head CT screening test [ 12 , 13 , 17 ]. While it has been demonstrated that substantial reduction of CT scans is achieved by implementing these guidelines [ 15 , 24 ], S100B testing has not been widely adopted as a routine by ED-physicians yet.…”

Section: Introductionmentioning

confidence: 99%

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Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Haselmann

Schamberger

Trifonova

et al. 2021

Practical Laboratory Medicine

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Background Serum biomarker S100B has been explored for its potential benefit to improve clinical decision-making in the management of patients suffering from traumatic brain injury (TBI), especially as a pre-head computed-tomography screening test for patients with mild TBI. Although being already included into some guidelines, its implementation into standard care is still lacking. This might be explained by a turnaround time (TAT) too long for serum S100B to be used in clinical decision-making in emergency settings. Methods S100B concentrations were determined in 136 matching pairs of serum and lithium heparin blood samples. The concordance of the test results was assessed by linear regression, Passing Pablok regression and Bland-Altman analysis. Bias and within- and between-run imprecision were determined by a 5 × 4 model using pooled patient samples. CT scans were performed as clinically indicated. Results Overall, S100B levels between both blood constituents correlated very well. The suitability of S100B testing from plasma was verified according to ISO15189 requirements. Using a cut-off of 0.105 ng/ml, a sensitivity and negative predictive value of 100% were obtained for identifying patients with pathologic CT scans. Importantly, plasma-based testing reduced the TAT to 26 min allowing for quicker clinical decision-making. The clinical utility of integrating S100B in TBI management is highlighted by two case reports. Conclusions Plasma-based S100B testing compares favorably with serum-based testing, substantially reducing processing times as the prerequisite for integrating S100B level into management of TBI patients. The proposed new clinical decision algorithm for TBI management needs to be validated in further prospective large-scale studies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Haselmann

Schamberger

Trifonova

et al. 2021

Practical Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…This is time-consuming, expensive and exposes the patient to potentially harmful radiation [ 14 , 15 ]. The annual ED influx of head-trauma patients is substantial [ 7 , 21 , 25 ]. Even small improvements in the clinical management that lead to decreased processing time, decreased use of radiation and/or decreased cost due to the use of brain biomarkers and other diagnostic tools, such as microwave machines, would benefit the health care system and patients alike [ 7 , 21 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…The study will be set at Helsingborg General Hospital, Helsingborg, Sweden. The hospital has a catchment area of 300,000 people and approximately 75,000 ED visits per annum with 1800 isolated TBI patients and another 1000 multi-trauma patients [ 25 ]. The SNC Guideline is the hospital recommended guideline.…”

Section: Methodsmentioning

confidence: 99%

“…Previous research has shown that patients with trauma to the head who are Glasgow Coma Scale (GCS) 13-15 do not have an increased risk of cervical spine injury [26]. A previous study by Vedin et al [7,21,25] at Helsingborg General Hospital on a very similar patient cohort has shown that approximately 99% of the patients are GCS 13-15. Hence, the theoretical risk of aggravating a pre-existing cervical spine injury is very low with this study design.…”

Section: Safetymentioning

confidence: 99%

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Microwave scan and brain biomarkers to rule out intracranial hemorrhage: study protocol of a planned prospective study (MBI01)

Vedin

Bergenfeldt

Holmström

et al. 2021

Eur J Trauma Emerg Surg

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Purpose The aim of this planned study is to evaluate the ability of a cranial microwave scanner in conjunction with nine brain biomarkers (Aβ40, Aβ42, GFAP, H-FABP, S100B, NF-L, NSE, UCH-L1 and IL-10) to detect and rule out traumatic intracranial hemorrhage in an emergency department setting. Traumatic brain injury is a world-wide topic of interest for researchers and clinicians. It affects 2% of the population per annum and presents challenges for physicians as patients’ initial signs and symptoms do not always correlate with the extent of brain injury. The gold standard for diagnosis of intracranial hemorrhage is head computerized tomography (CT) with the drawbacks of high cost and radiation exposure. A fast, secure way of diagnosing without these drawbacks has potential to make care more effective and reduce cost. Methods Study will be prospective and enroll adult, consenting patients with head trauma who seek emergency department care. Only patients where the treating physician prescribes a head-CT will be included. The microwave scan and blood sampling will be performed in close temporal proximity to the CT scan. Results will be analyzed with sensitivity, specificity and receiver operator characteristics analysis to provide the best combination of a number of biomarkers and the microwave scan. Conclusion This study will explore the diagnostic accuracy of a head microwave scanner in combination with biomarkers in ruling out intracranial hemorrhage in traumatic brain injury patients presenting to the emergency department. Potentially, this combined diagnostic approach could achieve both high sensitivity and high specificity, thereby reducing the need of CT-head scans when managing these patients. Clinicaltrials.gov identifier: NCT04666766. Registered December 11, 2020.

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Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study

Vedin

Forberg

Anefjäll

et al. 2022

Eur J Trauma Emerg Surg

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Background Traumatic brain injury (TBI) is a common injury and constitutes up to 3% of emergency department (ED) visits. Current studies show that TBI is most commonly inflicted in older patients after ground-level falls. These patients often take medications affecting coagulation such as anticoagulants or antiplatelet drugs. Guidelines for ED TBI-management assume that anticoagulation therapy (ACT) confers a higher risk of traumatic intracranial hemorrhage (TICH) than antiplatelet therapy (APT). However, recent studies have challenged this. This study aimed to evaluate if oral anticoagulation and platelet inhibitors affected rate of TICH in head-trauma patients with ground-level falls. Methods This was a retrospective review of medical records during January 1, 2017 to December 31, 2017 and January 1 2020 to December 31, 2020 of all patients seeking ED care because of head-trauma. Patients ≥ 18 years with ground-level falls were included. Results The study included 1938 head-trauma patients with ground-level falls. Median age of patients with TICH was 81 years. The RR for TICH in APT-patients compared to patients without medication affecting coagulation was 1.72 (p = 0.01) (95% Confidence Interval (CI) 1.13–2.60) and 1.08 (p = 0.73), (95% CI 0.70–1.67) in ACT-patients. APT was independently associated with TICH in regression analysis (OR 1.59 (95% CI 1.02–2.49), p = 0.041). Conclusion This study adds to the growing evidence that APT-patients with ground-level falls might have as high or higher risk of TICH than ACT-patients. This is not addressed in the current guidelines which may need to be updated. We therefore recommend broad prospective studies.

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A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

Cited by 8 publications

References 49 publications

Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Microwave scan and brain biomarkers to rule out intracranial hemorrhage: study protocol of a planned prospective study (MBI01)

Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study

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