Predictive value of neuromarkers supported by a set of clinical criteria in patients with mild traumatic brain injury: S100B protein and neuron-specific enolase on trial

Abstract

Object. The role of the neuromarkers S100B protein and neuron-specific enolase (NSE) in minor head injury is well established. Moreover, there are sensitive decision rules available in the literature to identify clinically important brain lesions. However, it is not clear if using the biomarkers has an influence on the predictability of the decision rule. The purpose of this study was to determine if a set of preclinical and clinical parameters combined with 2 neuromarker levels could serve as reliable guidance for accurate diagnosis.Methods. Prospective evaluation of a cohort of head trauma patients with Glasgow Coma Scale scores of 13-15 was performed at an academic, Level I trauma center. Blood samples and cranial CT studies were obtained for all patients within 3 hours after injury. The hypothesis of the study was whether the combination of an increase of S100B and NSE levels in serum and other defined risk factors are associated with a pathological finding on CT. A forward stepwise logistic regression model was used.Results. The study included 107 head trauma patients with a mean age of 59 ± 23 years. Twenty-five patients (23.4%) had traumatic lesions on CT. Eight patients underwent craniotomy. The analysis provided a model with good overall accuracy for discriminating cases with clinically important brain injury, including the 6 variables of S100B, NSE, nausea, amnesia, vomiting, and loss of consciousness. The area under the curve (AUC) was 0.88 (0.83-0.93). The receiver operating characteristic curve plots detecting clinically important brain injury for the single variables of S100B and NSE showed an AUC of 0.63 and 0.64, respectively.Conclusions. The integration of the neuromarker panel as part of a diagnostic rule including the high-risk factors of nausea, vomiting, amnesia, and loss of consciousness is safe and reliable in determining a diagnosis, pending the availability of more brain-specific neuromarkers. Clinical trial registration no.: NCT00622778 (ClinicalTrials.gov). (http://thejns.org/doi/abs/10.3171/2013.1.JNS121181) Key WordS • computed tomography scanning • adult brain injury • assessment tool • guideline • neuromarker • traumatic brain injuryAbbreviations used in this paper: AUC = area under the curve; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; NSE = neuron-specific enolase; ROC = receiver operating characteristic; TBI = traumatic brain injury.

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

“…Therefore, 22 articles were found, from which the mean ± SD value of S100B was extracted [10,[31][32][33][34][35][36][37]56,[86][87][88]91,93,[95][96][97][98][99]103,104,105]. In total, 1128 CT+ patients and 3221 CTÀ patients were assessed.…”

“…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].…”

Analysis of S100 Calcium Binding Protein B Serum Levels in Different Types of Traumatic Intracranial Lesions

“…1,2 It is used to detect brain damage after head trauma. 3 In 2006, a fundamental clinical multicenter study discovered that the serum concentration of S100B had a sensitivity level of 99% and a specificity level of 30% for the detection of intracranial bleeding (ICB) in patients with trauma-relevant brain lesions on CT scan. 4 Recent guidelines issued by the American College of Emergency Physicians recommend a cranial CT only in patients with a serum level of S100B > 0.1l/L.…”

Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule

“…29 Additionally, if available, the discrimination between clinically acute and nonacute lesions can be supported by the use of modern biomarkers such as S100-b, neuron-specific enolase, glial fibrillary acid protein, and ubiquitin carboxy-terminal hydrolase L1. 1,3,10,14,18,28 In these patients there is enough time to wait until the results of the biomarker essays are available.…”