Management of mild traumatic brain injury–trauma energy level and medical history as possible predictors for intracranial hemorrhage

Abstract

Purpose Head trauma is common in the emergency department. Identifying the few patients with serious injuries is time consuming and leads to many computerized tomographies (CTs). Reducing the number of CTs would reduce cost and radiation. The aim of this study was to evaluate the characteristics of adults with head trauma over a 1-year period to identify clinical features predicting intracranial hemorrhage. Methods Medical record data have been collected retrospectively in adult patients with traumatic brain injury. A total of 1638 patients over a period of 384 days were reviewed, and 33 parameters were extracted. Patients with high-energy multitrauma managed with ATLS™ were excluded. The analysis was done with emphasis on patient history, clinical findings, and epidemiological traits. Logistic regression and descriptive statistics were applied. Results Median age was 58 years (18-101, IQR 35-77). High age, minor head injury, new neurological deficits, and low trauma energy level correlated with intracranial hemorrhage. Patients younger than 59 years, without anticoagulation or antiplatelet therapy who suffered low-energy trauma, had no intracranial hemorrhages. The hemorrhage frequency in the entire cohort was 4.3% (70/1638). In subgroup taking anticoagulants, the frequency of intracranial hemorrhage was 8.6% (10/116), and in the platelet-inhibitor subgroup, it was 11.8% (20/169). Conclusion This study demonstrates that patients younger than 59 years with low-energy head trauma, who were not on anticoagulants or platelet inhibitors could possibly be discharged based on patient history. Maybe, there is no need for as extensive medical examination as currently recommended. These findings merit further studies.

Computational Design of Macrocyclic Binders of S100B(ββ): Novel Peptide Theranostics

“…Overexpression of S100B(ββ) protein is associated with several human diseases, such as cancer, inflammatory disorders and neurodegenerative conditions. S100B(ββ) is also a clinically validated marker for malignant melanoma (elevated only in tumours), traumatic brain injury (TBI) [ 19 , 20 , 21 , 22 , 23 ] and has been associated with cancer progression in multiple myeloma, NSCLC/SCLC and pancreatic cancer [ 24 , 25 , 26 , 27 , 28 ]. Despite being validated as a therapeutic target, S100B(ββ) remains undruggable with no approved drugs in clinics and no candidate molecules in pre-clinical development.…”

“…(C) Electrostatics surface representation (red to blue colours represent electrostatic potentials ranging from −5 to +5 kcal/mol) of the calcium bound S100B(ββ) protein dimer; the grey/white colour is localized to the hydrophobic pocket. S100B(ββ) is a clinically validated marker for malignant melanoma (elevated only in tumours) [19,20] and traumatic brain injury (TBI) [21][22][23] and has been associated with cancer progression in multiple myeloma (MM), NSCLC/SCLC, pancreatic cancer, etc., making it a potential target [24][25][26][27][28]. It is known to target p53 oligomerization and DNA binding [29][30][31][32][33], reducing their levels in multiple myeloma and in glioma cells [34,35].…”

Friend or Foe: S100 Proteins in Cancer

“…In this context, serum S100B demonstrates high sensitivity for the detection of ICI after mild TBI and analysing S100B levels brings great benefits, since only 8% of patients with mild TBI suffer from ICIs. Therefore, the application of cost-intensive computerised tomography (CT) can be reduced, and patients are protected from unnecessary exposure to radiation [63,64]. Changes in S100B levels were also found in patients with psychiatric diseases, such as schizophrenia, depression, and bipolar disorder, but more studies are needed to establish S100B as a reliable clinical biomarker [65].…”

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

“…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.…”