Usage of biomarker S100B to avoid CT after low-risk, mild head trauma: a single center clinical review of the Scandinavian head trauma guideline and guideline adherence

Abstract

Resume Baggrund I 2013 publicerede Scandinavian Neurotrauma Comittee (SNC) en ny retningslinje til håndtering af minimale, milde og moderate hovedtraumer. Retningslinjen inkluderede brugen af biomarkøren S100B til opsporing af patienter med behov for yderligere intervention, herunder computed tomography af cerebrum (CT-C). Formål Formålet med studiet er at undersøge brugen af S100B i forhold til retningslinjen fra SNC, herunder compliance af guideline. Metode Dette retrospektive kohortestudie var baseret på data fra alle S100B blodprøver taget i perioden 1 marts 2022 til 1 marts 2023 i en Dansk Akutmodtagelse. Resultat I alt blev blodprøver fra 236 patientjournaler inkluderet og kategoriseret ifølge SNC’s hovedtraumekategorier. Retningslinjen blev fulgt ved 152 af patientforløbene (64,4%). Det var hovedsageligt hos patienter med minimale og lav-risiko milde hovedtraumer, hvor brud på retningslinjen blev registreret. Årsagerne til manglende compliance var unødvendig rekvirering af S100B blodprøven, for sen blodprøvetagning, manglende eller unødvendige CT-C’er. Konklusion Retningslinje compliance var generelt udfordret, hvilket udgjorde en væsentlig del af resultaterne. For at kunne forbedre compliance er der behov for fremtidige studier, som kan klarlægge de forskellige årsager. Abstract Background In 2013, the Scandinavian Neurotrauma Committee (SNC) published a new guideline for managing minimal, mild and moderate head trauma. The guideline included the use of biomarker S100B to identify patients needing a head computed tomography (CT), among others. Purpose To explore the use of S100B in relation to the SNC guideline, including guideline adherence. Material and methods In this retrospective cohort study, data was collected for all consecutive S100B blood samples drawn in a Danish Emergency Department between March 1, 2022, and March 1, 2023 Results A total of 236 patient cases were included and categorized according to SNC head trauma categories. Guideline adherence was achieved for 152 patient cases (64.4%). Non-adherence (35.6%) was mainly seen in the minimal and low-risk, mild head trauma categories. The reasons for non-adherence were excessive S100B blood sampling, late blood sampling, and missing and excessive head CTs. Conclusion Guideline adherence was generally challenged and non-adherence was a substantial part of the results. Further studies are needed to explore reasons for non-adherence, and tools to improve guideline adherence.