Table 2.
Characteristics of the 26 Included Studies
| Study ID | BM | No TBI | GCS | Inclusion criteria | Prevalence of positive CT scan findings | Age (years)* | Sex (% female) | Polytrauma/ ECI |
|---|---|---|---|---|---|---|---|---|
| Asadollahi 201618 |
S100B |
158 |
13–15 |
History of isolated mTBI, age ≥18 yr., admission within 2 h of injury |
50% |
35.4 (15.8) |
48 (30.4%) |
No |
| Bazarian 201319 |
S100B |
787 |
13–15 |
GCS >13 measured 30’ or more after injury, patient age ≥1 yr., blood drawn within 6 h of injury, CT scan performed as part of the clinical care |
6% |
38.2 (19.5) Children & adolescents included |
287 (36.5%) |
Yes |
| Biberthaler 200120 |
S100B |
52 |
13–15 |
History of isolated MHT, GCS 13–15, at least one of the following symptoms: amnesia, LOC, nausea, vomiting, vertigo, or severe headache |
29% |
NR |
14 (27%) |
No |
| Biberthaler 20063 |
S100B |
1309 |
13–15 |
History of isolated head trauma, admission within 3 h, GCS 13–15 on admission, at least one of the following risk factors: LOC, PTA, nausea, vomiting, severe headache, dizziness, vertigo, intoxication, anticoagulation, age >60 yr. |
7% |
Median (IQR) 47 (32–75) |
454 (35%) |
No |
| Bouvier 200921 |
S100B |
105 |
13–15 |
History of isolated head trauma and admission within 3 h, GCS 13–15 on admission, at least one of the following risk factors: LOC, PTA, nausea, vomiting, severe headache, dizziness, vertigo, intoxication, anticoagulation, age >60 yr. |
15% |
53 (range 18–94; IQR 37) |
40 (38%) |
No |
| Calcagnile 201222 |
S100B |
512 |
14–15 |
History of head trauma, GCS 14–15 during examination and LOC <5’ and/or amnesia |
5% |
42.2 |
198 (38.5%) |
Unclear |
| Cervellin 201223 |
S100B |
60 |
14–15 |
History of MHI, GCS 14–15 on admission, patients with chronic neurological diseases, but not those with suspected/visible brain tumor |
33% |
58 (range 14–80) Adolescents included |
18 (32%) |
No |
| Cervellin 201424 |
S100B NSE |
68 |
14–15 |
History of MHI, GCS 13–15 at admission, age >14 yr. |
16% |
55 (range 15–86) Adolescents included |
24 (35%) |
Unclear |
| Egea-Guerrero 201225 |
S100B |
143 |
15 |
Patient age ≥14 yr., GCS 15 at hospital admission and one or more of the following symptoms: transitory LOC; amnesia; persistent headache; nausea or vomiting; and vertigo |
10.5% |
49 (20.6) Including pediatric population >14 |
54 (37.8%) |
Yes |
| Ingebrigtsen 200026 |
S100B |
182 |
13–15 |
Brain injury with brief LOC, GCS 13–15 at admission, age 15–80 yr., admission within 12 h post-injury, CT performed within 24 h after injury |
5% |
33 (range 15–78) Adolescents included |
71 (39%) |
Unclear |
| Laribi 201427 |
S100B |
431 |
13–15 |
History of isolated MHI; GCS 13–15 with one or more of the following: amnesia, LOC, nausea, vomiting, vertigo, anticoagulation before injury or severe headache on admission. Patient age ≥18 yr, admission within 3 h after injury |
6% |
Median (IQR) 36 (24–54) |
152 (35%) |
No |
| Ma 200828 |
Tau |
50 |
13–15 |
Patient age ≥18 yr., GCS 13–15 at admission, admission within 12 h of injury, CT performed as part of the clinical care, blunt head trauma followed by LOC and/or PTA |
20% |
40.3 (17.7) |
12 (24%) |
Unclear |
| McMahon 201529 |
GFAP |
215 |
3–15 |
Admission within 24 h of injury, positive clinical screen for acute TBI necessitating a noncontrast head CT according to ACEP/CDC evidence-based joint practice guidelines |
51% |
42.1 (18) (range 16–93) |
54 (27%) |
Yes |
| Morochovic 200930 |
S100B |
102 |
13–15 |
Patients with brain injury, GCS 13–15 with or without risk factors |
18% |
42.0 (19.7) (range 12–84) Including pediatric population |
31 (30.39%) |
Yes |
| Muller 200731 |
S100B |
236 |
13–15 |
History of brain injury; LOC or PTA; GCS 13–15 at admission; CT scan within 12 h of trauma |
9% |
39 (range 18–92) |
58 (25.7%) |
No |
| Muller 201132 |
S100B |
233 |
13–15 |
Adult patients (>16yr.), GCS 13–15 |
9% |
Median (IQR) 48.4 (24–72) (range 11–97) Adolescents included |
90 (39%) |
No |
| Mussack 200233 |
S100B NSE |
139 |
13–15 |
History of trauma, GCS 13–15, and at least one of the following symptoms: transient LOC (less than 5’), PTA, nausea, vomiting, or vertigo |
14% |
Median 36.0 |
33 (24%) |
No |
| Papa 201234 |
GFAP |
307 |
9–15 |
History of blunt head trauma followed by LOC, amnesia, or disorientation; GCS 9–15; admission to the ED within 4 h of injury; patient age ≥18 yr. |
30% |
39 (15) (range 18–89) |
38 (35%) |
Unclear |
| Papa 201235 |
UCH-L1 |
96 |
9–15 |
History of blunt head trauma followed by LOC, amnesia, or disorientation; GCS 9–15; admission to the ED within 4 h of injury; patient age ≥18 yr. |
29% |
39 (15) (range 18–89) |
36 (38%) |
Unclear |
| Papa 201436 |
S100B GFAP |
|
9–15 |
History of blunt head trauma followed by LOC, amnesia, or disorientation; GCS 9–15; admission to the ED within 4 h of injury; patient age ≥18 yr. |
10% |
40 (16) |
78 (37%) |
Yes |
| Poli-de-Figueiredo 200637 |
S100B |
50 |
13–15 |
Isolated MHI, GCS 13–15, at least one of the following symptoms: amnesia, LOC, nausea, vomiting, vertigo, or severe headache |
12% |
NR |
22 (44%) |
No |
| Romner 200038 |
S100B |
278 |
3–15 |
Brain injury with LOC, blood sample collected within 24 h after injury, and CT performed within 24 h after the injury. LOC was considered to have occurred when the patient had amnesia for the trauma event and if accompanying persons reported LOC. |
9% |
32 (range 1–84) Children & adolescents included |
103 (37%) |
Yes |
| Thaler 201539 |
S100B |
782 |
13–15 |
MHI (GCS Score 13–15) in patients on medication with PAI with age ≥18 yr., and MHI in patients with age ≥65 yr. independent of PAI intake; admission within 3 h of injury |
6% |
Median 83 (range 74–88) |
537 (68.7%) |
No |
| Welch 201640 |
S100B GFAP UCH-L1 |
251 |
9–15 |
GCS 9–15 on admission, patient age ≥18 <80 yr.; acceleration or deceleration closed injury to the head; admission within 4 h after injury; ED workup included a head CT scan. |
14% |
45.6 (18.4) (range 18–80) |
100 (39.8%) |
Unclear |
| Wolf 201341 |
S100B NSE |
107 |
13–15 |
GCS 13–15 at admission, blunt head trauma, admission to the ED within 3 h of injury |
23% |
59 (23) (range 18–97) |
47 (44%) |
No |
| Zongo 201242 | S100B | 1560 | 13–15 | Patient age ≥15 yr., GCS 13–15, admission to the ED within 6 h of injury, at least one of the following risk factors: LOC, PTA, repeated vomiting, severe headache, dizziness, vertigo, alcohol intoxication, anticoagulation, and age >65 yrs. | 7% | median (IQR) 57 (32–82) Adolescents included |
690 (44.2%) | No |
*
Mean (SD) unless stated otherwise.
ACEP/CDC, American College of Emergency Physicians/ Centers for Disease Control and Prevention; BM, biomarker; ECI, extracranial injury; ED, emergency department; GCS, Glasgow Coma Scale; GFAP, glial fibrillary acidic protein; IQR, interquartile range; LOC, loss of consciousness; MHI, mild head injury; MHT, mild head trauma; mTBI, mild traumatic brain injury; NR, not reported; NSE, neuron specific enolase; PAI, platelet aggregation inhibitor; PTA, post-traumatic amnesia; S100B, S100 calcium binding protein B; UCH-L1, ubiquitin C-terminal hydrolase-L1.