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Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury

  • Fleur Lorton ORCID logo EMAIL logo , Jeanne Simon-Pimmel , Damien Masson , Elise Launay , Christèle Gras-Le Guen and Pauline Scherdel
Published/Copyright: November 25, 2020
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 59 Issue 5

Abstract

Objectives

To evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children.

Methods

A before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013–2014) and after (2014–2015) implementation of a modified PECARN rule including the S100B protein assay.

Results

We included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013–2014 and 568 (53.5%) during 2014–2015. During 2014–2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9–40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013–2014 and 2014–2015. All children with ciTBI were identified by the rules.

Conclusions

The implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.

Keywords: biomarker; child; clinical decision rule; computed tomography; hospitalization; traumatic brain injury
Corresponding author: Fleur Lorton, MD, Service d’urgences pédiatriques, CHU de Nantes, Quai Moncousu, 44093 Nantes Cedex 01, France, Phone: +33 2 40 08 38 06, Fax: +33 2 40 08 46 45, E-mail:

Acknowledgments

The authors thank Drs. Baptiste Dumortier, Juliette Foucher and Maelle Lorvellec for participating in the data collection.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interest: FL has received travel grants from Pfizer, JSP has received travel grants from Roche Diagnostics, DM has received travel grants from Roche Diagnostics, EL has received travel grants from GSK, CGL has received travel grants from GSK, AbbVie, Astellas Pharma, bioMérieux, Chiesi SAS and Pfizer, fees from Pfizer, AbbVie and Roche Diagnostics. No other relationships or activities could appear to have influenced the submitted work.

  4. Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-1293).

Received: 2020-08-25
Accepted: 2020-11-05
Published Online: 2020-11-25
Published in Print: 2021-04-27

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2020-1293
Keywords for this article
biomarker; child; clinical decision rule; computed tomography; hospitalization; traumatic brain injury

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Home pregnancy tests: quality first
  4. Review
  5. Non-invasive determination of uric acid in human saliva in the diagnosis of serious disorders
  6. Opinion Papers
  7. Basophil counting in hematology analyzers: time to discontinue?
  8. The role of laboratory hematology between technology and professionalism: the paradigm of basophil counting
  9. Recommendations for validation testing of home pregnancy tests (HPTs) in Europe
  10. General Clinical Chemistry and Laboratory Medicine
  11. The use of preanalytical quality indicators: a Turkish preliminary survey study
  12. The Italian External Quality Assessment (EQA) program on urinary sediment by microscopy examination: a 20 years journey
  13. Non-HDL-C/TG ratio indicates significant underestimation of calculated low-density lipoprotein cholesterol (LDL-C) better than TG level: a study on the reliability of mathematical formulas used for LDL-C estimation
  14. Evaluation of the protein gap for detection of abnormal serum gammaglobulin level: an imperfect predictor
  15. Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury
  16. Using machine learning to develop an autoverification system in a clinical biochemistry laboratory
  17. Effect of collection matrix, platelet depletion, and storage conditions on plasma extracellular vesicles and extracellular vesicle-associated miRNAs measurements
  18. Pneumatic tube transportation of urine samples
  19. Evaluation of the first immunosuppressive drug assay available on a fully automated LC-MS/MS-based clinical analyzer suggests a new era in laboratory medicine
  20. A validated LC-MS/MS method for the simultaneous quantification of the novel combination antibiotic, ceftolozane–tazobactam, in plasma (total and unbound), CSF, urine and renal replacement therapy effluent: application to pilot pharmacokinetic studies
  21. Immunosuppressant quantification in intravenous microdialysate – towards novel quasi-continuous therapeutic drug monitoring in transplanted patients
  22. Reference Values and Biological Variations
  23. Reference intervals for venous blood gas measurement in adults
  24. Cardiovascular Diseases
  25. Detection and functional characterization of a novel MEF2A variation responsible for familial dilated cardiomyopathy
  26. Diabetes
  27. Evaluation of the ARKRAY HA-8190V instrument for HbA1c
  28. Infectious Diseases
  29. An original multiplex method to assess five different SARS-CoV-2 antibodies
  30. Evaluation of dried blood spots as alternative sampling material for serological detection of anti-SARS-CoV-2 antibodies using established ELISAs
  31. Variability of cycle threshold values in an external quality assessment scheme for detection of the SARS-CoV-2 virus genome by RT-PCR
  32. The vasoactive peptide MR-pro-adrenomedullin in COVID-19 patients: an observational study
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  44. Significant interference on specific point-of-care glucose measurements due to high dose of intravenous vitamin C therapy in critically ill patients
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  49. Automated Mindray CL-1200i chemiluminescent assays of renin and aldosterone for the diagnosis of primary aldosteronism
  50. Use of common reference intervals does not necessarily allow inter-method numerical result trending
  51. Reply to Dr Hawkins regarding comparability of results for monitoring
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