S100B Blood Level Determination for Early Management of Ski-Related Mild Traumatic Brain Injury: A Pilot Study

Abstract

Background: Mild traumatic brain injury (mTBI) management in emergency departments is a complex process involving clinical evaluation, laboratory testing, and computerized tomography (CT) scanning. Protein S100B has proven to be a useful blood biomarker for early evaluation of mTBI, as it reduces the required CT scans by one-third. However, to date, the ability of S100B to identify positive abnormal findings in the CT scans of patients suffering from mTBI caused by ski practice has not been investigated. Thus, the primary aim of this study was to investigate the diagnostic performance of S100B as an mTBI management biomarker in patients with ski-related mTBI. Materials and Methods: One hundred and thirty adult mTBI patients presenting to the emergency department of Hôpital du Valais in Sion, Switzerland, with a Glasgow Coma Scale (GCS) score of 13-15 and clinical indication for a CT scan were included in the study. Blood samples for S100B measurement were collected from each patient and frozen in 3-hour post-injury intervals. CT scans were performed for all patients. Later, serum S100B levels were compared to CT scan findings in order to evaluate the biomarker's performance. Results: Of the 130 included cases of mTBI, 87 (70%) were related to ski practice. At the internationally established threshold of 0.1 µg/L, the receiver operating characteristic curve of S100B serum levels for prediction of abnormal CT scans showed 97% sensitivity, 11% specificity, and a 92% negative predictive value. Median S100B concentrations did not differ according to sex, age, or GCS score. Additionally, there was no significant difference between skiers and non-skiers. However, a statistically significant difference was found when comparing the median S100B concentrations of patients who suffered fractures or had polytrauma and those who did not suffer fractures. Kahouadji et al. S100B and Ski-Related mTBI Patient Management Conclusion: The performance of S100B in post-mTBI brain lesion screenings seems to be affected by peripheral lesions and/or ski practice. The lack of neurospecificity of the biomarker in this context does not allow unnecessary CT scans to be reduced by one-third as expected.

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

“…A recent study showed an S100B increase in muscle cells in patients with sarcopenia (42). Another study showed higher S100B blood levels in patients with acute fractures without apparent cerebral injury (43,44). A higher incidence of sarcopenia and fractures in older people could also explain the S100B increase in this population (42,45).…”

The Current State of Traumatic Brain Injury Biomarker Measurement Methods

“…The first clinical parameter is the choice of biomarker. GFAP and UCH-L1 are FDA cleared for assessing TBIs in the United States, and S100B is approved in Europe [23,24], but only 9 out of 25 devices described in the literature measured GFAP, 7 devices measured S100B, and not a single device measured UCH-L1. To improve the chances of device translation, the measured biomarkers should already have proven clinical utility.…”

“…As of June 2021, only GFAP and ubiquitin c-terminal hydrolase L1 (UCH-L1) are FDA cleared to aid in determining the need for evaluation with a head CT scan in the United States [23]. S100B is currently used for the same purpose in Europe and may result in a decrease in head CT utilization [24]. Thorough discussions of the current state of TBI biofluid biomarkers can be found in recent reviews by , Gan et al, and Slavoaca et al [25][26][27].…”

The Potential of S100 Calcium-Binding Protein B and Glial Fibrillary Acid Protein in Predicting the Intracranial Lesions in Mild Traumatic Brain Injury: A Systematic Review of Literature

“…No randomized control studies were identified. A pediatric sample was used in four studies [21], [22], [23], [24], and a sample older than 16 years was used in ten studies [25], [26], [27], [28], [29], [30], [31], [32], [33], [34]. A skier was utilized as a test subject in one research.…”

“…A skier was utilized as a test subject in one research. S100B was studied in the majority of studies, with total of 13 of the 14 studies [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], whereas the GFAP biomarker was discussed in 3 studies [26], [29], [34]. Two studies studied both S100B and GFAP biomarker.…”