Management of traumatic brain injury in an aging population: Role of S100, CT and anticoagulation in 10.051 patients

Objective The aim of this study was to investigate the benefit of the S100B level as a substitute for computed tomography (CT) in assessing brain injury in cases of traumatic brain injury (TBI). The hypothesis was that the S100B level would exhibit high negative sensitivity, thereby potentially obviating the need for CT scans and the associated radiation exposure in certain patients. Methods A cohort of 11,504 patient cases with TBI was collected from 04/2016 to 07/2022 at a level I trauma centre, where both CT scans and S100B measurements were performed. Those cases were classified and coded based on diagnosis, age and pathology. These results were analyzed with respect to radiologically diagnosed pathologies and the levels of S100B. Subsequently, a comparison was made to assess the correlation between pathology findings and negative S100B levels. Results Out of the 11,504 cases included in this study, 6% showed evidence of intracranial hemorrhage (ICH) and possible neurocranial fracture while 5% exhibited neurocranial fractures without concurrent ICH. The patient cohort of 3,920 individuals under known anticoagulation medication revealed that 5% displayed signs of ICH and possible neurocranial fracture and 4% exhibited neurocranial fractures without concurrent ICH. 483 cases with valid S100B measurements were identified of those, 36% were treated as inpatients showing an NPV of 73%, while 64% received outpatient care showing an NPV of 98%. Conclusions We found a clear and significant correlation between a negative S100B level and normal CT scan. We believe that the determination of S100B levels significantly reduces the radiation exposure for TBI patients.