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Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Update on the role of S100B in traumatic brain injury in pediatric population: a meta-analysis
Alberto Morello1, Irene Schiavetti2, Enrico Lo Bue3
1Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy. alberto.morello@unito.it.
Insights
Serum S100B measurement shows high sensitivity and negative predictive value for pediatric traumatic brain injury (TBI). This biomarker may help reduce CT scans in children, but further research is needed for regular clinical use.
Area of Science:
- Pediatric Traumatic Brain Injury (TBI)
- Biomarker Discovery
- Radiology and Imaging
Background:
- Cranial computed tomography (CT) is standard for diagnosing intracranial lesions in pediatric TBI.
- Radiation exposure from CT scans in children increases risks of hematological and brain cancers.
- Serum biomarkers, like S100B, are emerging as potential tools to aid TBI management.
Purpose of the Study:
- To systematically review the utility of serum S100B as a biomarker for intracranial lesions in pediatric TBI.
- To evaluate the diagnostic accuracy of S100B in predicting the need for CT scans in children with TBI.
- To assess the potential of S100B to reduce CT scan utilization in pediatric TBI cases.
Main Methods:
- Systematic review conducted following PRISMA protocol.
- Inclusion of studies reporting serum S100B measurements and CT scans in pediatric TBI patients.
- Meta-analysis of pooled sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV).
Main Results:
- 10 studies involving 1325 patients with mild TBI were included.
- Pooled sensitivity was 98% and specificity was 45%.
- High pooled NPV (99%) and low PPV (41%) were observed, with an AUC of 76%.
Conclusions:
- Serum S100B measurement can aid decision-making in pediatric TBI, potentially reducing CT scan use.
- High sensitivity and NPV suggest S100B is a promising biomarker in pediatric TBI.
- Further studies are required to establish pediatric-specific cut-off levels and address high study heterogeneity before regular clinical adoption.
Objective:
Cranial computed tomography (CT) scan is the most widely used tool to rule out intracranial lesions after pediatric traumatic brain injury (TBI). However, in pediatric population, the radiation exposure can lead to an increased risk of hematological and brain neoplasm. Defined in 2019 National Institute for Health and Care Excellence (NICE) guidelines as "troponins for the brain", serum biomarkers measurements, particularly S100B, have progressively emerged as a supplementary tool in the management of TBI thanks to their capacity to predict intracranial post-traumatic lesions.
Methods:
This systematic review was conducted following the PRISMA protocol (preferred reporting items for systematic reviews and meta-analyses). No chronological limits of study publications were included. Studies reporting data from children with TBI undergoing serum S100B measurement and computed tomography (CT) scans were included.
Results:
Of 380 articles screened, 10 studies met the inclusion criteria. Patients admitted with mild-TBI in the Emergency Department (ED) were 1325 (80.25%). The overall pooled sensitivity and specificity were 98% (95% CI, 92-99%) and 45% (95% CI, 29-63%), respectively. The meta-analysis revealed a high negative predictive value (NVP) (99%; 95% CI, 94-100%) and a low positive predictive value (PPV) (41%; 95% CI, 16-79%). Area under the curve (AUC) was 76% (95% CI, 65-85%). The overall pooled negative predictive value (NPV) was 99% (95% CI, 99-100%).
Conclusions:
The measurement of serum S100B in the diagnostic workflow of mTBI could help informed decision-making in the ED setting, potentially safely reducing the use of CT scan in the pediatric population. The high sensitivity and excellent negative predictive values look promising and seem to be close to the values found in adults. Despite this, it must be pointed out the high heterogeneity (> 90%) found among studies. In order for S100B to be regularly introduced in the pediatric workflow for TBI, it is important to conduct further studies to obtain cut-off levels based on pediatric reference intervals.
