Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury

Area of Science:

• Pediatric Emergency Medicine
• Neurotrauma Management
• Biomarker Application

Background:

• Mild traumatic brain injury (mTBI) in children often necessitates careful evaluation to rule out clinically important traumatic brain injury (ciTBI).
• The Pediatric Emergency Care Applied Research Network (PECARN) rules provide a guideline for managing pediatric head injuries.
• The S100B protein assay is a potential biomarker for detecting brain injury.

Purpose of the Study:

• To assess the impact of integrating the S100B protein assay into a modified PECARN rule for managing pediatric mTBI.
• To evaluate the effect on the utilization of computed tomography (CT) scans and in-hospital observations.

Main Methods:

• A before-and-after study was conducted in a pediatric emergency department.
• Consecutive children aged 4 months to 15 years with mTBI and intermediate risk for ciTBI were included.
• Proportions of CT scans and observations were compared before and after implementing the modified PECARN rule with S100B assay.

Main Results:

• 1,062 children with mTBI were analyzed; 494 before and 568 after rule implementation.
• The proportion of CT scans decreased from 14.4% to 9.5% (p=0.02).
• In-hospital observations dropped significantly from 73.9% to 40.5% (p<0.01), with CT scans per ciTBI reduced by two-thirds.

Conclusions:

• Implementing a modified PECARN rule with the S100B protein assay significantly reduced CT scan rates and in-hospital observations in children with mTBI.
• This strategy effectively identified all children with ciTBI while decreasing unnecessary investigations.
• The modified rule offers a more efficient approach to managing pediatric mTBI at intermediate risk.