Serum S100B Levels Can Predict Computed Tomography Findings in Paediatric Patients with Mild Head Injury

Abstract

Introduction Traumatic brain injuries (TBIs) are very common in paediatric populations, in which they are also a leading cause of death. Computed tomography (CT) overuse in these populations results in ionization radiation exposure, which can lead to lethal malignancies. The aims of this study were to investigate the accuracy of serum S100B levels with respect to the detection of cranial injury in children with mild TBI and to determine whether decisions regarding the performance of CT can be made based on biomarker levels alone. Materials and Methods This was a single-center prospective cohort study that was carried out from December 2016 to December 2017. A total of 80 children with mild TBI who met the inclusion criteria were included in the study. The patients were between 2 and 16 years of age. We determined S100B protein levels and performed head CTs in all the patients. Results Patients with cranial injury, as detected by CT, had higher S100B protein levels than those without cranial injury (p < 0.0001). We found that patients with cranial injury (head CT+) had higher mean S100B protein levels (0.527 μg L−1, 95% confidence interval (CI) 0.447–0.607 μg L−1) than did patients without cranial injury (head CT−) (0.145 μg L−1, 95% CI 0.138–0.152 μg L−1). Receiver operating characteristic (ROC) curve analysis clearly showed that S100B protein levels differed between patients with and without cranial injury at 3 hours after TBI (AUC = 0.893, 95% CI 0.786–0.987, p = 0.0001). Conclusion Serum S100B levels cannot replace clinical examinations or CT as tools for identifying paediatric patients with mild head injury; however, serum S100B levels can be used to identify low-risk patients to prevent such patients from being exposed to radiation unnecessarily.

The validity of Protein S 100B in Mild Pediatric Head Trauma

“…Kelmendi et al, [14] conducted a study on a total of 80 individuals with mild TBI who met the inclusion criteria for this investigation, which agrees with our findings. Forty-six patients were male [57.5%], and 34 patients were female [42.5%].…”

S100β protein levels as a parameter to assess the clinical development of adult patients with mild traumatic brain injury in Dr. Moewardi Public Hospital, Surakarta

“…[ 13 ] The half-life of S100β (30–100 min) which will then be secreted in the kidneys so that the maximum interval between trauma events and serum intake is 3 h.[ 8 ] An advantage of S100β is that it is stable and relatively unaffected by storing, changer temperature, and freeze-thaw cycles, not affected by hemolysis in the sample. [ 15 ] It is important to know that after 12 h, there was a decrease in S100β at the end of the 1st day, which is consistent with kinetic modeling where the peak of the main injury was found at 27 h.[ 15 ] The functional protein is implicated in variety of intracellular and extracellular regulatory activities (e.g., protein phosphorylation, cell motility, neuronal differentiation, and proliferation). [ 14 ] Several studies raised substantial hints that the measurement of S100ß in the systemic circulation of mTBI patients might be an additional valuable tool to optimize clinical decision for the development of the patient outcome and as initial research avoiding unnecessary head CT scan.…”

“…Unfortunately, ELISA assays take 4–6 h to run and generally present higher inter- and intra-coefficients of variations compared to clinical assays, resulting in worse functional sensitivity of the device, making them difficult in the clinic. [ 15 ]…”

“…[ 14 ] It was named because of the solubility in 100% saturated solution with ammonium sulfate. [ 15 ] In the central nervous system, S100β is also to be produced by oligodendrocytes, Schwann cells, enteric glial cells, and neuronal progenitor cells. [ 11 ] Outside the brain, S100β is secreted by adipocytes, alveolar cells, cardiomyocytes, and chondrocytes, but has the highest concentration in astrocytes.…”

“…This might be of importance when calculating outcome from TBI in patients with darker skin, as higher serum levels may be falsely interpreted as elevated, resulting in an unnecessary CT scan in mild TBI. [ 15 ]…”