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Head injury outcome prediction in the emergency department: a role for protein S-100B?
  1. M T Wunderlich1
  1. 1Department of Neurology, Otto-von-Guericke University, Leipziger Straβe 44, Magdeburg 39120, Germany;

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    I read with great interest the recent article by Townend et al1 in which the authors studied the predictive value of protein S-100B in patients with head injury upon performance in the extended Glasgow outcome scale (GOSE). One important criticism is that the study was performed in patients with head injury defined as “any blow to the head causing a clinical diagnosis of head injury to be made, even if insufficient to cause definite loss of consciousness” and not only in patients with traumatic brain injury, which is defined at least through loss of consciousness, amnesia, or postconcussion syndrome. Consequently, relevant abnormality of the brain even in minor traumatic brain injury was only detected in a few patients.

    In addition, cerebral computed tomography (CT) was only performed in 15 of 148 patients. The extent of possible traumatic brain injury in the patients in the study by Townend et al1 cannot be estimated. Patients with frontal contusion lesions in CCT and/or diffuse axonal injury were not separately identified in this study. Those patients are at high risk of having neuropsychological deficits and also frequently suffer from loss of insight. This may falsify the outcome measured by the extended Glasgow coma scale that was obtained by telephone interview only. Assessment by phone has limitations and cannot substitute a detailed neurological and neuropsychological …

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