Clinical validation of S100B use in management of mild head injury

<p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p< Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Calcagnile Olga [verfasserIn] Undén Linda [verfasserIn] Undén Johan [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2012

Übergeordnetes Werk:	In: BMC Emergency Medicine - BMC, 2003, 12(2012), 1, p 13
Übergeordnetes Werk:	volume:12 ; year:2012 ; number:1, p 13

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1186/1471-227X-12-13

Katalog-ID:	DOAJ026794470

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allfields	10.1186/1471-227X-12-13 doi (DE-627)DOAJ026794470 (DE-599)DOAJaa0c3027208144c4bb270c8bd8c60841 DE-627 ger DE-627 rakwb eng RC952-1245 RC86-88.9 Calcagnile Olga verfasserin aut Clinical validation of S100B use in management of mild head injury 2012 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p< Special situations and conditions Medical emergencies. Critical care. Intensive care. First aid Undén Linda verfasserin aut Undén Johan verfasserin aut In BMC Emergency Medicine BMC, 2003 12(2012), 1, p 13 (DE-627)33101873X (DE-600)2050431-7 1471227X nnns volume:12 year:2012 number:1, p 13 https://doi.org/10.1186/1471-227X-12-13 kostenfrei https://doaj.org/article/aa0c3027208144c4bb270c8bd8c60841 kostenfrei http://www.biomedcentral.com/1471-227X/12/13 kostenfrei https://doaj.org/toc/1471-227X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2012 1, p 13
spelling	10.1186/1471-227X-12-13 doi (DE-627)DOAJ026794470 (DE-599)DOAJaa0c3027208144c4bb270c8bd8c60841 DE-627 ger DE-627 rakwb eng RC952-1245 RC86-88.9 Calcagnile Olga verfasserin aut Clinical validation of S100B use in management of mild head injury 2012 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p< Special situations and conditions Medical emergencies. Critical care. Intensive care. First aid Undén Linda verfasserin aut Undén Johan verfasserin aut In BMC Emergency Medicine BMC, 2003 12(2012), 1, p 13 (DE-627)33101873X (DE-600)2050431-7 1471227X nnns volume:12 year:2012 number:1, p 13 https://doi.org/10.1186/1471-227X-12-13 kostenfrei https://doaj.org/article/aa0c3027208144c4bb270c8bd8c60841 kostenfrei http://www.biomedcentral.com/1471-227X/12/13 kostenfrei https://doaj.org/toc/1471-227X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2012 1, p 13
allfields_unstemmed	10.1186/1471-227X-12-13 doi (DE-627)DOAJ026794470 (DE-599)DOAJaa0c3027208144c4bb270c8bd8c60841 DE-627 ger DE-627 rakwb eng RC952-1245 RC86-88.9 Calcagnile Olga verfasserin aut Clinical validation of S100B use in management of mild head injury 2012 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p< Special situations and conditions Medical emergencies. Critical care. Intensive care. First aid Undén Linda verfasserin aut Undén Johan verfasserin aut In BMC Emergency Medicine BMC, 2003 12(2012), 1, p 13 (DE-627)33101873X (DE-600)2050431-7 1471227X nnns volume:12 year:2012 number:1, p 13 https://doi.org/10.1186/1471-227X-12-13 kostenfrei https://doaj.org/article/aa0c3027208144c4bb270c8bd8c60841 kostenfrei http://www.biomedcentral.com/1471-227X/12/13 kostenfrei https://doaj.org/toc/1471-227X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2012 1, p 13
allfieldsGer	10.1186/1471-227X-12-13 doi (DE-627)DOAJ026794470 (DE-599)DOAJaa0c3027208144c4bb270c8bd8c60841 DE-627 ger DE-627 rakwb eng RC952-1245 RC86-88.9 Calcagnile Olga verfasserin aut Clinical validation of S100B use in management of mild head injury 2012 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p< Special situations and conditions Medical emergencies. Critical care. Intensive care. First aid Undén Linda verfasserin aut Undén Johan verfasserin aut In BMC Emergency Medicine BMC, 2003 12(2012), 1, p 13 (DE-627)33101873X (DE-600)2050431-7 1471227X nnns volume:12 year:2012 number:1, p 13 https://doi.org/10.1186/1471-227X-12-13 kostenfrei https://doaj.org/article/aa0c3027208144c4bb270c8bd8c60841 kostenfrei http://www.biomedcentral.com/1471-227X/12/13 kostenfrei https://doaj.org/toc/1471-227X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2012 1, p 13
allfieldsSound	10.1186/1471-227X-12-13 doi (DE-627)DOAJ026794470 (DE-599)DOAJaa0c3027208144c4bb270c8bd8c60841 DE-627 ger DE-627 rakwb eng RC952-1245 RC86-88.9 Calcagnile Olga verfasserin aut Clinical validation of S100B use in management of mild head injury 2012 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p< Special situations and conditions Medical emergencies. Critical care. Intensive care. First aid Undén Linda verfasserin aut Undén Johan verfasserin aut In BMC Emergency Medicine BMC, 2003 12(2012), 1, p 13 (DE-627)33101873X (DE-600)2050431-7 1471227X nnns volume:12 year:2012 number:1, p 13 https://doi.org/10.1186/1471-227X-12-13 kostenfrei https://doaj.org/article/aa0c3027208144c4bb270c8bd8c60841 kostenfrei http://www.biomedcentral.com/1471-227X/12/13 kostenfrei https://doaj.org/toc/1471-227X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2012 1, p 13
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title	Clinical validation of S100B use in management of mild head injury
ctrlnum	(DE-627)DOAJ026794470 (DE-599)DOAJaa0c3027208144c4bb270c8bd8c60841
title_full	Clinical validation of S100B use in management of mild head injury
author_sort	Calcagnile Olga
journal	BMC Emergency Medicine
journalStr	BMC Emergency Medicine
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lang_code	eng
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publishDateSort	2012
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author_browse	Calcagnile Olga Undén Linda Undén Johan
container_volume	12
class	RC952-1245 RC86-88.9
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author-letter	Calcagnile Olga
doi_str_mv	10.1186/1471-227X-12-13
author2-role	verfasserin
title_sort	clinical validation of s100b use in management of mild head injury
callnumber	RC952-1245
title_auth	Clinical validation of S100B use in management of mild head injury
abstract	<p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p<
abstractGer	<p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p<
abstract_unstemmed	<p<Abstract</p< <p<Background</p< <p<Despite validated guidelines, management of mild head injury (MHI) is still associated with excessive computed tomography (CT) scanning. Reports concerning serum levels of S100B have shown promise concerning safe reduction in CT scanning but clinical validation and actual impact on patient management is unclear. In 2007, S100B was introduced into emergency department (ED) clinical management routines in Halmstad, Sweden. MHI patients with low (<0.10 mikrogram/L) levels of S100B could be discharged without CT. Our aim was to examine the clinical impact and performance of S100B in clinical use for MHI patients.</p< <p<Methods</p< <p<Adult ([≥]18 years) patients with MHI (GCS 14–15, loss of consciousness and/or amnesia and no additional risk factors) and S100B sampling within 3 hours were prospectively included in this validation study. Patients were managed according to the adapted guidelines and management was documented. Outcome was determined with a questionnaire 3 months post-trauma and medical records to identify significant intracranial complications such as new neuroimaging, neurosurgery and/or death related to the trauma.</p< <p<Results</p< <p<512 patients were included. 24 (4.7%) showed traumatic abnormalities on CT and 1 patient died (0.2%). 138 patients (27%) had normal S100B levels and 374 patients (73%) showed elevated S100B levels. No patients with a normal S100B level showed significant intracranial complication. 44 patients (32%) were managed with CT despite the guidelines recommending discharge (all these CT scans were normal) and 28 patients (7%) were discharged despite a CT recommendation (follow-up was normal in all these patients). S100B had a sensitivity of 100% (95% CI 83-100%) and a specificity of 28% (95% CI 24-33%) for significant intracranial complications.</p< <p<Conclusion</p< <p<The clinical use of S100B within our existing guidelines for management of MHI is safe and effective. Adult MHI patients, without additional risk factors and with normal S100B levels within 3 hours of injury, can safely be discharged from the hospital.</p<
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container_issue	1, p 13
title_short	Clinical validation of S100B use in management of mild head injury
url	https://doi.org/10.1186/1471-227X-12-13 https://doaj.org/article/aa0c3027208144c4bb270c8bd8c60841 http://www.biomedcentral.com/1471-227X/12/13 https://doaj.org/toc/1471-227X
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up_date	2024-07-03T22:58:41.023Z
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