The risk for acute intracranial complication after minor head injury (MHI) is low. Despite this, computed tomography (CT) scan is generally recommended for all patients following MHI. Admission for clinical observation is a secondary management option when a CT scan is unavailable or judged inappropriate. Both these choices are associated with disadvantages and several attempts at refining existing guidelines for MHI management, in order to reduce CT and/or admission, have been proposed. However, these are based on potentially unreliable patient history and clinical examination and may furthermore be compromised by patient factors such as intoxication. A number of clinical studies from several research groups have shown the potential of brain biomarker S100B in this patient category. The specificity of S100B is poor but a high sensitivity for brain damage results in a clinically-useful high negative predictive value (NPV) for relevant complications after MHI. Used in conjunction with existing guidelines, serum levels of S100B can accurately identify patients who do not need a CT scan after MHI. Based on 6 prospective studies comprising almost 2000 patients with MHI, the sensitivity and NPV of S100B for CT findings were 98.2% and 99.5%, respectively, and for clinically relevant intracranial complications 100% and 100%, respectively. Integration of S100B into existing management routines can reduce the need for CT scans by 30% resulting in an improved and more efficient patient care.
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|Published - 24 Jun 2008