Use of biomarker S100B for traumatic brain damage in the emergency department may change observation strategy

The revised Scandinavian Neurotrauma Committee (SNC) guidelines on management of patients with head trauma include an option for measurement of S100B in peripheral blood with 100% sensitivity for neurosurgical intervention. A medical technology assessment was conducted to evaluate any impact of using S100B on the use of computed tomographies (CT) of the brain and admission for observation.

Patients referred for assessment of head injury over a period of 1.5 months had their blood sampled for measurement of S100B in serum. Results were not available to the treating physician and treatment was conducted according to existing practice. Patient records were reviewed retrospectively and post hoc divided into two groups depending on whether the SNC criteria for taking the blood sample were met. The use of CT and admission was analysed.

A total of 39 patients had their blood sampled for analysis. In all, 12 patients were excluded in pursuance of SNC guidelines, which left 27 patients for analysis. A total of 15 patients had abnormally high S100B levels. Using the SNC criteria, only eight of these qualified a priori for blood sampling. Furthermore, seven of the 11 patients who were admitted had normal S100B levels.

The number of patients with an above-threshold concentration of S100B was almost equally distributed between those fulfilling the SNC criteria for S100B assessment and those who could have been discharged without further evaluation. Using S100B as a screening tool may lead to an increase in the use of CTs of the brain. In relation to admission, measurement of S100B may contribute to the adoption of an appropriate observation strategy.

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