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Head injury outcome prediction in the emergency department: a role for protein S-100B?
  1. W J Townend1,
  2. M J Guy2,
  3. M A Pani4,
  4. B Martin3,
  5. D W Yates3
  1. 1Emergency Department, Hope University Hospital, Salford, UK
  2. 2Biochemistry Department, Hope University Hospital
  3. 3Emergency Department, Hope University Hospital
  4. 4Department of Internal Medicine, University Hospital, Frankfurt-am-Main, Germany
  1. Correspondence to:
 Dr W Townend, Emergency Department, Hope University Hospital, Salford M6 8HD, UK;
 wtownend{at}fs1.ho.man.ac.uk

Abstract

Background: Biochemical markers released after head injury may reflect the degree of brain damage, which is related to subsequent disability. If the serum level of a marker were found to be related to outcome, then earlier identification and intervention would be possible.

Objective: To investigate the potential of the serum marker S-100B protein to predict the outcome after head injury.

Methods: Blood samples for S-100B concentrations were taken from 148 adults within six hours of a head injury (initial Glasgow coma score 4–15). Patients were recruited from the emergency departments of four hospitals in Greater Manchester, United Kingdom. Outcome was assessed in 119 patients (80%) at one month using the extended Glasgow outcome scale (GOSE).

Results: A significant inverse correlation between serum S-100B level and GOSE was found (Spearman’s ρ = −0.349, p < 0.0001). A serum S-100B concentration of > 0.32 μg/l predicted severe disability (GOSE < 5) at one month with a sensitivity of 93% (95% confidence interval 68% to 100%), a specificity of 72% (54% to 79%), and a negative predictive value of 99% (93% to 100%).

Conclusion: Serum S-100B concentration can be used in the emergency department to identify patients with head injury who are most likely to have a poor outcome at one month.

  • head injury
  • outcome prediction
  • S-100B protein

https://doi.org/10.1136/jnnp.73.5.542

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    Footnotes

    • Competing interests: S-100B assay kits were provided at a reduced cost and the luminometer on which the assays were performed was supplied free of charge by Cambridge Life Sciences for the duration of the study. Byk-Sangtec Diagnostica are part sponsoring a further study in the Academic Department of Emergency Medicine, Hope Hospital.