Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2002 Nov;73(5):542–546. doi: 10.1136/jnnp.73.5.542

Head injury outcome prediction in the emergency department: a role for protein S-100B?

W Townend 1, M Guy 1, M Pani 1, B Martin 1, D Yates 1
PMCID: PMC1738097  PMID: 12397148

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.

Full Text

The Full Text of this article is available as a PDF (132.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson R. E., Hansson L. O., Nilsson O., Dijlai-Merzoug R., Settergren G. High serum S100B levels for trauma patients without head injuries. Neurosurgery. 2001 Jun;48(6):1255–1260. doi: 10.1097/00006123-200106000-00012. [DOI] [PubMed] [Google Scholar]
  2. Blomquist S., Johnsson P., Lührs C., Malmkvist G., Solem J. O., Alling C., Ståhl E. The appearance of S-100 protein in serum during and immediately after cardiopulmonary bypass surgery: a possible marker for cerebral injury. J Cardiothorac Vasc Anesth. 1997 Oct;11(6):699–703. doi: 10.1016/s1053-0770(97)90160-9. [DOI] [PubMed] [Google Scholar]
  3. Herrmann M., Curio N., Jost S., Grubich C., Ebert A. D., Fork M. L., Synowitz H. Release of biochemical markers of damage to neuronal and glial brain tissue is associated with short and long term neuropsychological outcome after traumatic brain injury. J Neurol Neurosurg Psychiatry. 2001 Jan;70(1):95–100. doi: 10.1136/jnnp.70.1.95. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hodgkinson D. W., Berry E., Yates D. W. Mild head injury--a positive approach to management. Eur J Emerg Med. 1994 Mar;1(1):9–12. doi: 10.1097/00063110-199403000-00003. [DOI] [PubMed] [Google Scholar]
  5. Ingebrigtsen T., Romner B., Kongstad P., Langbakk B. Increased serum concentrations of protein S-100 after minor head injury: a biochemical serum marker with prognostic value? J Neurol Neurosurg Psychiatry. 1995 Jul;59(1):103–104. doi: 10.1136/jnnp.59.1.103-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ingebrigtsen T., Waterloo K., Jacobsen E. A., Langbakk B., Romner B. Traumatic brain damage in minor head injury: relation of serum S-100 protein measurements to magnetic resonance imaging and neurobehavioral outcome. Neurosurgery. 1999 Sep;45(3):468–476. doi: 10.1097/00006123-199909000-00010. [DOI] [PubMed] [Google Scholar]
  7. Jackson R. G., Samra G. S., Radcliffe J., Clark G. H., Price C. P. The early fall in levels of S-100 beta in traumatic brain injury. Clin Chem Lab Med. 2000 Nov;38(11):1165–1167. doi: 10.1515/CCLM.2000.179. [DOI] [PubMed] [Google Scholar]
  8. Jennett B., Bond M. Assessment of outcome after severe brain damage. Lancet. 1975 Mar 1;1(7905):480–484. doi: 10.1016/s0140-6736(75)92830-5. [DOI] [PubMed] [Google Scholar]
  9. Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry. 1996 Apr;60(4):362–369. doi: 10.1136/jnnp.60.4.362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jennett B., MacMillan R. Epidemiology of head injury. Br Med J (Clin Res Ed) 1981 Jan 10;282(6258):101–104. doi: 10.1136/bmj.282.6258.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jennett B., Snoek J., Bond M. R., Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981 Apr;44(4):285–293. doi: 10.1136/jnnp.44.4.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jönsson H., Johnsson P., Höglund P., Alling C., Blomquist S. Elimination of S100B and renal function after cardiac surgery. J Cardiothorac Vasc Anesth. 2000 Dec;14(6):698–701. doi: 10.1053/jcan.2000.18444. [DOI] [PubMed] [Google Scholar]
  13. Levin H. S., Boake C., Song J., Mccauley S., Contant C., Diaz-Marchan P., Brundage S., Goodman H., Kotrla K. J. Validity and sensitivity to change of the extended Glasgow Outcome Scale in mild to moderate traumatic brain injury. J Neurotrauma. 2001 Jun;18(6):575–584. doi: 10.1089/089771501750291819. [DOI] [PubMed] [Google Scholar]
  14. Raabe A., Grolms C., Keller M., Döhnert J., Sorge O., Seifert V. Correlation of computed tomography findings and serum brain damage markers following severe head injury. Acta Neurochir (Wien) 1998;140(8):787–792. doi: 10.1007/s007010050180. [DOI] [PubMed] [Google Scholar]
  15. Raabe A., Grolms C., Seifert V. Serum markers of brain damage and outcome prediction in patients after severe head injury. Br J Neurosurg. 1999 Feb;13(1):56–59. doi: 10.1080/02688699944195. [DOI] [PubMed] [Google Scholar]
  16. Romner B., Ingebrigtsen T., Kongstad P., Børgesen S. E. Traumatic brain damage: serum S-100 protein measurements related to neuroradiological findings. J Neurotrauma. 2000 Aug;17(8):641–647. doi: 10.1089/089771500415391. [DOI] [PubMed] [Google Scholar]
  17. Rothoerl R. D., Woertgen C., Holzschuh M., Metz C., Brawanski A. Rapid evaluation of S-100 serum levels. Case report and comparison to previous results. Brain Inj. 1999 May;13(5):387–391. doi: 10.1080/026990599121584. [DOI] [PubMed] [Google Scholar]
  18. Sapsed-Byrne S., Gao F., Harris D. N. Neurone-specific enolase and Sangtec 100 assays during cardiac surgery: Part II--Must samples be spun within 30 min? Perfusion. 1997 May;12(3):167–169. doi: 10.1177/026765919701200304. [DOI] [PubMed] [Google Scholar]
  19. Teasdale G. M., Pettigrew L. E., Wilson J. T., Murray G., Jennett B. Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. J Neurotrauma. 1998 Aug;15(8):587–597. doi: 10.1089/neu.1998.15.587. [DOI] [PubMed] [Google Scholar]
  20. Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. doi: 10.1016/s0140-6736(74)91639-0. [DOI] [PubMed] [Google Scholar]
  21. Thornhill S., Teasdale G. M., Murray G. D., McEwen J., Roy C. W., Penny K. I. Disability in young people and adults one year after head injury: prospective cohort study. BMJ. 2000 Jun 17;320(7250):1631–1635. doi: 10.1136/bmj.320.7250.1631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Usui A., Kato K., Abe T., Murase M., Tanaka M., Takeuchi E. S-100ao protein in blood and urine during open-heart surgery. Clin Chem. 1989 Sep;35(9):1942–1944. [PubMed] [Google Scholar]
  23. Wade D. T., Crawford S., Wenden F. J., King N. S., Moss N. E. Does routine follow up after head injury help? A randomised controlled trial. J Neurol Neurosurg Psychiatry. 1997 May;62(5):478–484. doi: 10.1136/jnnp.62.5.478. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wade D. T., King N. S., Wenden F. J., Crawford S., Caldwell F. E. Routine follow up after head injury: a second randomised controlled trial. J Neurol Neurosurg Psychiatry. 1998 Aug;65(2):177–183. doi: 10.1136/jnnp.65.2.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Wilson J. T., Pettigrew L. E., Teasdale G. M. Emotional and cognitive consequences of head injury in relation to the glasgow outcome scale. J Neurol Neurosurg Psychiatry. 2000 Aug;69(2):204–209. doi: 10.1136/jnnp.69.2.204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Wilson J. T., Pettigrew L. E., Teasdale G. M. Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma. 1998 Aug;15(8):573–585. doi: 10.1089/neu.1998.15.573. [DOI] [PubMed] [Google Scholar]
  27. van der Naalt J., van Zomeren A. H., Sluiter W. J., Minderhoud J. M. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry. 1999 Feb;66(2):207–213. doi: 10.1136/jnnp.66.2.207. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES