경도 두부손상 환자에서 S-100B 단백질과 위험인자가 뇌전산화단층촬영 시행에미치는 영향 (The Effect of S-100B Protein and RiskFactors on Indication of CranialComputed Tomography in Patientswith Minor Head Injury)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 19권 / 3호 / 303 ~ 312페이지
· 저자명 : 안승찬, 류석용, 조석진, 이상래, 오성찬, 김홍용

초록

Purpose: S-100B protein is a reliable biomarker of brain
injury. The clinical decision rules for screening of a cranial
computed tomography (CCT) in minor head injury patients
remain controversial. The purpose of this study was to
determine whether S-100B protein and risk factors for
minor head injury patients can provide meaningful insights
to improve initial CCT scanning of patients with MHI.
Methods: Fifty patients with MHI were enrolled in this
prospective study from July 2007 to September 2007. All
patients who fulfilled the following inclusion criteria were
enrolled: history of head trauma, initial GCS score of 14 to
15, and one or more clinical findings. Risk factors of
patients presented in this study included age younger than
2 years or above sixty years, focal neurologic deficit (FND),
post-traumatic seizure, skull fracture, extra-cranial injury,
coagulopathy, previous neurologic deficit and ingestion of
toxicants (drugs or alcohol). A venous blood sample for
assessment of S-100B protein was drawn and a CCT scan
was undergone. The reference value of S-100B protein was
0.105 μg/L. All CCT findings were confirmed by radiologists.
Results: Of the 50 patients studied, 15 patients exhibited
trauma-relevant intracranial lesions on the CCT scan (CCTpositive).
The subgroups of CCT-positive and -negative
showed no statistically difference in S-100B level (p=0.068).
Of the fifty patients, thirteen had no risk factors (RF).
However, statistically significant differences were observed
in S-100B level when the subgroups were classified into
RF-positive and RF-negative groups (p=0.016). The CCTpositive
findings of 13 patients with no RF were identified
with 100% sensitivity, 54.6% specificity, 28.6% positive predictive
value and 100% negative predictive value through
assessment of S-100B protein level.
Conclusion: In patients with MHI, S-100B protein level and
risk factors may give us reliable predictive information prior
to CCT screening in emergency department.

영어초록

Purpose: S-100B protein is a reliable biomarker of brain
injury. The clinical decision rules for screening of a cranial
computed tomography (CCT) in minor head injury patients
remain controversial. The purpose of this study was to
determine whether S-100B protein and risk factors for
minor head injury patients can provide meaningful insights
to improve initial CCT scanning of patients with MHI.
Methods: Fifty patients with MHI were enrolled in this
prospective study from July 2007 to September 2007. All
patients who fulfilled the following inclusion criteria were
enrolled: history of head trauma, initial GCS score of 14 to
15, and one or more clinical findings. Risk factors of
patients presented in this study included age younger than
2 years or above sixty years, focal neurologic deficit (FND),
post-traumatic seizure, skull fracture, extra-cranial injury,
coagulopathy, previous neurologic deficit and ingestion of
toxicants (drugs or alcohol). A venous blood sample for
assessment of S-100B protein was drawn and a CCT scan
was undergone. The reference value of S-100B protein was
0.105 μg/L. All CCT findings were confirmed by radiologists.
Results: Of the 50 patients studied, 15 patients exhibited
trauma-relevant intracranial lesions on the CCT scan (CCTpositive).
The subgroups of CCT-positive and -negative
showed no statistically difference in S-100B level (p=0.068).
Of the fifty patients, thirteen had no risk factors (RF).
However, statistically significant differences were observed
in S-100B level when the subgroups were classified into
RF-positive and RF-negative groups (p=0.016). The CCTpositive
findings of 13 patients with no RF were identified
with 100% sensitivity, 54.6% specificity, 28.6% positive predictive
value and 100% negative predictive value through
assessment of S-100B protein level.
Conclusion: In patients with MHI, S-100B protein level and
risk factors may give us reliable predictive information prior
to CCT screening in emergency department.

참고자료

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