Classification Accuracy of Serum Apo A-I and S100B for the Diagnosis of Mild Traumatic Brain Injury and Prediction of Abnormal Initial Head Computed Tomography Scan

Abstract

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.

Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009–2010

“…A number of different approaches, including clinical decision rules, 36–38 circulating biomarkers 2, 4, 13, 39, 40 and quantitative brain electrical activity 7 have been proposed as strategies identifying patients evaluated for TBI who are at high risk of having traumatic abnormalities on their head CT scan. Among existing clinical decision rules, the Canadian head CT rule holds the most promise for reducing avoidable head CTs in TBI evaluation.…”

Psychological and cognitive impairment of long‐term migrators to high altitudes and the relationship to physiological and biochemical changes

“…Hypoxia can negatively affect the metabolism, structure, membrane potentials and neurotransmitter release of neurocytes. It is well recognized that S100B levels correlate strongly with the extent of craniocerebral injuries . BDNF was shown to be a protective and regulatory factor in promoting neuronal survival and damage repair, particularly with respect to synaptic function and plasticity .…”

S100B protein as a screening tool for computed tomography findings after mild traumatic brain injury: Systematic review and meta-analysis

“…From these, 285 potentially relevant papers were screened. Finally, 79 were found eligible [10, and 26 full-text articles were included for the meta-analysis and were studied in detail [10,[31][32][33][34]36,37,48,56,[86][87][88][89]91,93,[95][96][97][98][99][100][101][102][103][104][105] (Table I). The flow of information from identification to inclusion of studies is summarized in Figure 1 using the PRISMA flow diagram [106].…”

“…Table II shows the sensitivity and specificity for a cut-point range ¼ 0.10-0.15 mg L À1 in S100B concentration. In subgroup analysis of 13 studies, 1059 CT+ patients and 3251 CTÀ patients were included [10,31,33,53,56,86,89,93,[96][97][98][99][100]. In this case, the cut-point has the sensitivity of 93 …”