Predictive Performance of Blood S100B in the Management of Patients Over 65 Years Old With Mild Traumatic Brain Injury

Oris, Charlotte; Bouillon‐Minois, Jean‐Baptiste; Pinguet, Jérémy; Kahouadji, Samy; Durif, Julie; Meslé, Vallauris; Pereira, Bruno; Schmidt, Jeannot; Sapin, Vincent; Bouvier, Damien

doi:10.1093/gerona/glab055

Cited by 22 publications

(17 citation statements)

References 56 publications

(64 reference statements)

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“…The levels of some brain injury markers increase with age [19][20][21]. We therefore performed age-adjusted analyses, in which concentrations were normalized to the single seizure group-mean for the corresponding age group.…”

Section: Statistical Analysesmentioning

confidence: 99%

Brain injury markers in new-onset seizures in adults: A pilot study

Eriksson

Banote

Larsson

et al. 2021

Seizure

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Background: Biochemical markers of brain pathology could potentially contribute to diagnosis and prediction in epilepsy. We describe levels of five brain injury markers in adults with new-onset seizures, and assess group differences in patients with a single seizure, epilepsy, and poststroke epilepsy. Methods: In this prospective observational study, adults with new-onset seizures were recruited at Sahlgrenska University Hospital, Sweden, and concentrations of glial fibrillary acidic protein (GFAP), neurofilament light (NfL), microtubule-associated protein tau (tau), S100 calcium-binding protein (S100B), and neuron-specific enolase (NSE) were measured. Participants were categorized as epilepsy, poststroke epilepsy (PSE), or single seizure (no additional seizures). Patients were followed until a diagnosis of epilepsy or PSE, or for at least two years in single seizure cases. Results: The cohort included 23 (37%) individuals with a single seizure, 24 (39%) with epilepsy, and 15 (24%) with PSE. The concentrations of S100B were higher in patients with epilepsy and PSE than in single seizures (p = 0.0023 and p = 0.0162, respectively). The concentrations of NfL were higher in patients with PSE than in single seizures (p=0.0027). After age-normalization, levels of S100B were higher in patients with epilepsy and levels of NfL were higher in patients with PSE (p = 0.0021 and p = 0.0180). Conclusion: Levels of S100B and NfL were higher in patients with epilepsy or PSE than patients with single seizures. Further studies are needed to investigate the biomarker potential of brain injury markers as predictors of epilepsy course or indicators of epileptogenesis.

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Section: Statistical Analysesmentioning

confidence: 99%

Brain injury markers in new-onset seizures in adults: A pilot study

Eriksson

Banote

Larsson

et al. 2021

Seizure

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“…This is likely to have increased the rate of false positives observed in our cohort, and clinically this could limit the reduction in CT-head rates. S100B levels can also be affected by poor renal function and increasing age, and potentially a higher S100B threshold could be more appropriate in the over 65 age group 30. Furthermore, a high proportion of patients in this study were on anticoagulation, and although there is no evidence to suggest this affects S100B levels,31 further consideration is required.…”

Section: Discussionmentioning

confidence: 88%

Diagnostic performance of S100B as a rule-out test for intracranial pathology in head-injured patients presenting to the emergency department who meet NICE Head Injury Guideline criteria for CT-head scan

Rogan

Sik²,

Dickinson³

et al. 2022

Emerg Med J

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BackgroundTraumatic brain injury is a common ED presentation. CT-head utilisation is escalating, exacerbating resource pressure in the ED. The biomarker S100B could assist clinicians with CT-head decisions by excluding intracranial pathology. Diagnostic performance of S100B was assessed in patients meeting National Institute of Health and Clinical Excellence Head Injury Guideline (NICE HIG) criteria for CT-head within 6 and 24 hours of injury.MethodsThis multicentre prospective observational study included adult patients presenting to the ED with head injuries between May 2020 and June 2021. Informed consent was obtained from patients meeting NICE HIG CT-head criteria. A venous blood sample was collected and serum was tested for S100B using a Cobas Elecsys-S100 module; >0.1 µg/mL was the threshold used to indicate a positive test. Intracranial pathology reported on CT-head scan by the duty radiologist was used as the reference standard to review diagnostic performance.ResultsThis study included 265 patients of whom 35 (13.2%) had positive CT-head findings. Within 6 hours of injury, sensitivity of S100B was 93.8% (95% CI 69.8% to 99.8%) and specificity was 30.8% (22.6% to 40.0%). Negative predictive value (NPV) was 97.3% (95% CI 84.2% to 99.6%) and area under the curve (AUC) was 0.73 (95% CI 0.61 to 0.85; p=0.003). Within 24 hours of injury, sensitivity was 82.9% (95% CI 66.4% to 93.44%) and specificity was 43.0% (95% CI 36.6% to 49.7%). NPV was 94.29% (95% CI 88.7% to 97.2%) and AUC was 0.65 (95% CI 0.56 to 0.74; p=0.046). Theoretically, use of S100B as a rule-out test would have reduced CT-head scans by 27.1% (95% CI 18.9% to 36.8%) within 6 hours and 37.4% (95% CI 32.0% to 47.2%) within 24 hours. The risk of missing a significant injury with this approach would have been 0.75% (95% CI 0.0% to 2.2%) within 6 hours and 2.3% (95% CI 0.5% to 4.1%) within 24 hours.ConclusionWithin 6 hours of injury, S100B performed well as a diagnostic test to exclude significant intracranial pathology in low-risk patients presenting with head injury. In theory, if used in addition to NICE HIGs, CT-head rates could reduce by one-quarter with a potential miss rate of <1%.

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“…S100B levels can also be affected by poor renal function and increasing age and potentially a higher S100B threshold could be more appropriate in the over 65 age group. 42 Furthermore, a high proportion of patients in this study were on anticoagulation and although there is no evidence to suggest this affects S100B levels, 43 further evidence is required.…”

Section: Limitationsmentioning

confidence: 87%

Diagnostic performance of S100B as a rule out test for intracranial pathology in head injured patients presenting to the Emergency Department who meet NICE CT-head criteria- A BRAIN Project Study

Rogan

Sik

Dickinson

et al. 2022

Preprint

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Background: Traumatic brain injury (TBI) is a common Emergency Department (ED) presentation. CT-head utilisation is escalating, exacerbating resource pressure in ED. The biomarker S100B could assist clinicians with CT-head decisions by excluding intracranial pathology. Diagnostic performance of S100B was assessed in patients meeting NICE CT-head criteria within 6 and 24-hours of injury. Methods: This multi-centre prospective observational study included adult patients presenting to ED with mild TBI who were able to give their own informed consent and had a CT-head scan performed as part of standard care. Patients were recruited using consecutive sampling methods. Informed consent was obtained prior to blood sampling. Serum was tested for S100B using a Cobas Elecsys S100 module; >0.1ug/ml is the validated threshold indicating a positive test. Diagnostic performance was assessed using ROC analysis as well as sensitivity, specificity, NPV and PPV calculations. Results: There were 265 included patients, and 35 (13.2%) had a positive CT-head. The sensitivity of S100B when performed within 24 hours of injury was 82.9% (95%CI 66.4-93.44) and specificity was 43.0% (95%CI 36.6–49.7%). NPV was 94.29% (95%CI 88.7–97.2). Within 6 hours sensitivity was 93.8% (95%CI 69.8–99.8%) and specificity was 30.8% (22.6–40.0%). NPV was 97.3% (95%CI 84.2–99.6%). Theoretically, use of S100B as a rule out test would have reduced CT scans by 37.4% within 24 hours and 27.1% within 6-hours. The risk of missing a significant injury with this approach would have been 2.3% within 24 hours and 0.75% within 6-hours. Conclusion Within 6-hours of injury, S100B performed well as a diagnostic test to exclude significant intracranial pathology in patients presenting with mild head injuries, with low risk of missed injury. In theory, if used in addition to NICE CT-head guidelines, CT-head request rates could reduce by one quarter and one fifth of patients could be discharged earlier from ED. What is already known on this topic S100B has shown promise diagnostically as an objective marker that can rule out intracranial injuries in head injured patients. S100B has a validated platform that could potentially be used to reduce CT head demand in ED. However, evidence testing the added value of biomarkers to existing clinical guidelines are limited. What this study adds This study demonstrates that S100B could theoretically reduce CT-head demand and enable earlier ED discharge in low-risk patients meeting NICE CT-head criteria. The included population were GCS 15, had no post traumatic amnesia and were able to consent for themselves. This low-risk population have a low yield of traumatic CT abnormalities and could be a suitable population to target biomarker use. How this study might affect research, practice or policy S100B has the potential to reduce CT-head demand, thereby benefitting EDs by reducing overcrowding, resource burden and healthcare costs; and from the patients’ perspective, enable shorter waits, earlier intervention and earlier discharge. Further research should focus on optimising the performance of S100B within the NICE CT-head guidelines in low-risk patients, and review real-time economic benefits.

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Predictive Performance of Blood S100B in the Management of Patients Over 65 Years Old With Mild Traumatic Brain Injury

Cited by 22 publications

References 56 publications

Brain injury markers in new-onset seizures in adults: A pilot study

Brain injury markers in new-onset seizures in adults: A pilot study

Diagnostic performance of S100B as a rule-out test for intracranial pathology in head-injured patients presenting to the emergency department who meet NICE Head Injury Guideline criteria for CT-head scan

Diagnostic performance of S100B as a rule out test for intracranial pathology in head injured patients presenting to the Emergency Department who meet NICE CT-head criteria- A BRAIN Project Study

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