Abstract
The majority of patients with mild traumatic brain injury (mTBI) will have normal Glasgow coma scale (GCS) of 15. Furthermore, only 5%–8% of them will be CT-positive for an mTBI. Having a useful biomarker would help clinicians evaluate a patient’s risk of developing intracranial lesions. The S100B protein is currently the most studied and promising biomarker for this purpose. Heart fatty-acid binding protein (H-FABP) has been highlighted in brain injury models and investigated as a biomarker for stroke and severe TBI, for example. Here, we evaluate the performances of S100B and H-FABP for differentiating between CT-positive and CT-negative patients. A total of 261 patients with a GCS score of 15 and at least one clinical symptom of mTBI were recruited at three different European sites. Blood samples from 172 of them were collected ≤ 6 h after trauma. Patients underwent a CT scan and were dichotomised into CT-positive and CT-negative groups for statistical analyses. H-FABP and S100B levels were measured using commercial kits, and their capacities to detect all CT-positive scans were evaluated, with sensitivity set to 100%. For patients recruited ≤ 6 h after trauma, the CT-positive group demonstrated significantly higher levels of both H-FABP (p = 0.004) and S100B (p = 0.003) than the CT-negative group. At 100% sensitivity, specificity reached 6% (95% CI 2.8–10.7) for S100B and 29% (95% CI 21.4–37.1) for H-FABP. Similar results were obtained when including all the patients recruited, i.e. hospital arrival within 24 h of trauma onset. H-FABP out-performed S100B and thus seems to be an interesting protein for detecting all CT-positive mTBI patients with a GCS score of 15 and at least one clinical symptom.
Highlights
Mild traumatic brain injury is common worldwide, with an annual incidence estimated to be above 600/100,000 individuals.[1]
A total of 261 patients with a Glasgow coma scale (GCS) score of 15 and at least one clinical symptom of Mild traumatic brain injury (mTBI) were recruited at three different European sites
Patients needed to fulfil several inclusion criteria: diagnosis of mTBI with a GCS score of 15; presence of at least one clinical symptom; CT scan performed within 24 h of the trauma
Summary
Mild traumatic brain injury (mTBI) is common worldwide, with an annual incidence estimated to be above 600/100,000 individuals.[1]. Several guidelines have put forward decision rules for handling mTBI patients, based primarily on the GCS and risk factors (e.g. clinical symptoms).[3,5] this still means that every patient with a symptom will probably undergo a CT-scan. Another approach, which has been widely studied, is the use of blood-based biomarkers. There remains a need to further investigate S100B’s effectiveness (or that of other biomarkers), in conjunction with clinical risk factors, at differentiating between CT-positive and CT-negative patients
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