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Selected Publication:
Singer, M.
Added value of the S100B protein in the radiological assessment of traumatic brain injury?
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2021. pp. 81
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- Authors Med Uni Graz:
- Advisor:
- Fuchsjäger Michael
- Igrec Jasminka
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- Abstract:
- Introduction: The potential use of the S100B protein regarding diagnosis, monitoring and outcome estimation of traumatic brain injury (TBI) in daily clinical practice is still a matter of discussion. Currently, the focus lies especially on the fact whether S100B serum values can predict pathological cranial computed tomography (cCT) findings and whether cCT scans (along with radiation exposure) can be avoided for certain patients. In this regard, a big challenge arises by other influence factors, like extracranial injuries, of S100B serum values. In 2013, the Scandinavian Neurotrauma Committee (SNC) added S100B serum values for the first time to official guidelines. Methods: This study was based on retrospective data analysis from 01/01/2017 to 31/01/2020 of patients, who suffered TBI and sought medical help at the Hospital of the Medical University of Graz, receiving both a cCT scan and S100B sampling (n = 110). Different CT classifications (Marshall, Rotterdam, Stockholm, and Helsinki) were compared with S100B serum values. Additionally, the impact of important influence factors like extracranial injuries or times between trauma and S100B sampling on S100B serum values has been analyzed in detail. Results: At a cut-off value of 0,100 µg/L sensitivity of S100B predicting pathologies in CT was 94,7% (100% for the group defined by SNC guidelines), while specificity was 17,6% (21,2% regarding SNC guidelines). Specificity for patients suffering polytrauma (n = 11) was 0%, for patients with multiple injuries (n = 41) it was 5,3%. All the four CT classifications correlated significantly (n = 110, p < ,01, R = ,376 to R = ,468) with S100B serum levels. Time from trauma to S100B sampling did not significantly correlate to S100B serum levels for patients without pathologies in CT scan (n = 23, p = ,429, R = -,173). However, time from hospitalization to S100B sampling did show a significant correlation (n = 91, p = ,006, R = -,287). Conclusion: Extracranial injuries have a major influence on S100B serum values. Therefore, it must be concluded that a cut off value of S100B ≥ 0,100 µg/L is not suitable for patients with multiple injuries and further research is necessary for this group. Adjusted cut off values depending on the length of time between trauma and S100B sampling may potentially increase the specificity, however there are still too many uncertainties about the detailed kinetics of the S100B protein.