MEASUREMENT OF S-100B FOR RISK CLASSIFICATION OF VICTIMS SUSTAINING MINOR HEAD INJURY - FIRST PILOT STUDY IN BRAZIL

• Published in: Clinics (São Paulo, Brazil) Vol. 61; no. 1; pp. 41 - 46
• Main Authors: Poli-de-Figueiredo, Luiz F, Biberthaler, Peter, Filho, Charles Simao, Hauser, Christopher, Mutschler, Wolf, Jochum, Marianne
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-02-2006; Faculdade de Medicina / USP
• Subjects: Biomarkers - blood; Brazil; Cranial computed tomography; Craniocerebral Trauma - blood; Craniocerebral Trauma - classification; Craniocerebral Trauma - diagnosis; Escala de Coma de Glasgow; Female; Glasgow coma scale; Humans; Male; MEDICINE, GENERAL & INTERNAL; Minor head injury; Nerve Growth Factors - blood; Neuronal protein S-100B; Pilot Projects; Prospective Studies; Proteína S100B; Reproducibility of Results; S100 Calcium Binding Protein beta Subunit; S100 Proteins - blood; Sensitivity and Specificity; Tomografia de crânio; Tomography, X-Ray Computed; Trauma de crânio; Trauma Severity Indices; Brazil; Proteína S100B; Neuronal protein S-100B; Tomografia de crânio; Trauma de crânio; Minor head injury; Glasgow coma scale; Escala de Coma de Glasgow; Cranial computed tomography
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.1590/S1807-59322006000100008

Release of the neuronal protein S-100B into the circulation has been suggested as a specific indication of neuronal damage. The hypothesis that S-100B is a useful and cost-effective screening tool for the management of minor head injuries was tested.
Fifty consecutive patients sustaining isolated minor head injury were prospectively evaluated in the emergency room of a Brazilian hospital by routine cranial computed tomography scan. Venous blood samples (processed to serum) were assssayed for S-100B using a newly developed immunoassay test kit. Twenty-one normal healthy individuals served as negative controls. Data are presented as median and 25 to 75 percentiles.
Patients reached the emergency room an average of 45 minutes (range: 30–62 minutes) after minor head injury. Six of 50 patients (12%) showed relevant posttraumatic lesions in the initial cranial computed tomography scan and were counted as positive. The median systemic concentration of S-100B in those patients was 0.75 μg/L (range: 0.66–6.5 μg/L), which was significantly different (U-test, P < .05) from the median concentration of 0.26 μg/L (range: 0.12–0.65 μg/L), of patients without posttraumatic lesions as counted by the cranial computed tomography. A sensitivity of 100%, a specificity of 20%, a positive predictive value of 15%, and a negative predictive value of 100% was calculated for the detection of patients suffering from intracranial lesions.
Protein S-100B had a very high sensitivity and negative predictive value and could have an important role in ruling out the need for cranial computed tomography scan after minor head injury. This appears to be of substantial clinical relevance, particularly in countries where trauma incidence is high and medical resources are limited, such as in Brazil.
A liberação da proteína neuronal S-100B na circulação tem sido sugerida como indicadora de dano neuronal. Foi testada a hipótese de que a S-100B é um marcador útil e custo efetivo para a triagem de pacientes com trauma craniano leve.
Cinqüenta pacientes consecutivos com trauma craniano isolado foram prospectivamente avaliados na sala de emergência de um Centro de Trauma brasileiro pela tomografia computadorizada de crânio e por amostras de sangue venoso, para a medida no soro da proteína S-100B utilizando um teste recentemente desenvolvido; 21 pessoas normais foram utilizadas como controles negativos. Os resultados são apresentados como mediana e percentis 25-75.
Os pacientes chegaram ao Centro de Trauma em média 45 min (30-62) após o trauma craniano leve. Seis dos 50 pacientes tiveram lesões pós-traumáticas relevantes segundo a tomografia computadorizada de crânio inicial (12%) e foram considerados como positivos. A concentração mediana de S-100B nestes pacientes foi de 0,75μg/L (0,66-6,5), significativamente maior (U-teste, p<0,05) do que a concentração mediana de 0,26μg/L (0.12-0.65) dos pacientes sem lesões pós-traumáticas, segundo a tomografia computadorizada de crânioCCT-. O cálculo para a detecção dos pacientes com lesões intra-cranianas revelou sensibilidade de 100%, especificidade de 20%, valor preditivo positivo de 15% and valor preditivo negativo de 100%.
A proteína S-100B tem altas taxas de sensibilidade e valor preditivo negativo, podendo ter um importante papel para descartar a necessidade de tomografia de crânio após trauma craniano leve. Acreditamos que este achado é de relevância clínica, principalmente em países onde o trauma é muito frequente e os recursos médicos limitados.