Published online September 28, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. e697-e704 (doi:10.1542/peds.2008-1493)
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ARTICLE

Relationship of Serum S100B Levels and Intracranial Injury in Children With Closed Head Trauma

Kirsten Bechtel, MDa, Sarah Frasure, BAa, Clement Marshall, BSb, James Dziura, PhDc and Christine Simpson, MSc

a Department of Pediatrics
c Yale Center for Clinical Investigation, Yale University School of Medicine, New Haven, Connecticut
b Department of Biochemistry, Brown University School of Medicine, Providence, Rhode Island

OBJECTIVE: To determine if serum levels of S100B are higher in children with CHT and ICI as detected by cranial CT and if long bone fractures affect the level of S100B in children with CHT and skeletal injury.

METHODS: Children <18 years of age who presented to an urban pediatric emergency department or were transferred from a referral hospital within 6 hours after accidental closed head trauma and who underwent cranial computed tomography were enrolled prospectively. Mean serum S100B levels for children with or without intracranial injury (ICI) and long-bone fractures were evaluated through analysis of covariance.

RESULTS: One hundred fifty-two children, 24 with ICI and 128 without ICI, were enrolled prospectively. Twenty-five children had long-bone fractures. Children with ICI were significantly younger than those without ICI (6.9 vs 9.8 years; P = .01). The time of venipuncture after injury was significantly later in children with ICI (P = .03). Mean S100B levels were significantly greater for children with ICI (212.9 vs 84.4 ng/L; P = .001), children with long-bone fractures (P = .008), and nonwhite children (P = .03). After controlling for time of venipuncture, long-bone fractures, and race, mean S100B levels were still greater for children with ICI (409 vs 118 ng/L; P = .001). The ability of serum S100B measurements to detect ICI, determined as the area under the curve, was 0.67.

CONCLUSIONS: After controlling for time of venipuncture, long-bone fractures, and race, S100B levels were still higher in children with ICI than in those without ICI. However, the ability of serum S100B measurements to detect ICI was poor.

Key Words: closed head trauma • intracranial injury • pediatric emergency department • S100B

Abbreviations: CHT—closed head trauma • ICI—intracranial injury • CT—computed tomography • AUC—area under the curve • GCS—Glasgow Coma Scale • ED—emergency department • PED—pediatric emergency department

Accepted May 29, 2009.


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