gms | German Medical Science

Background: Blunt head trauma is a frequent injury pattern in children. The consecutive traumatic brain injury remains a leading cause of mortality and morbidity. Management strategies for major head trauma with neurological symptoms are well established. In minor head trauma, however, the amount of necessary primary diagnostic procedures is not clearly defined. S-100b is a well known marker of neuronal damage after traumatic brain injury, but it has rarely been evaluated in paediatric patients.

Methods: We present a prospective study in which S-100b was measured in serum of patients within the first six hours after head trauma. Patients were admitted to the ward due to symptoms such as recurrent vomiting, nausea, headache or skull fracture in the x-ray. If available, a correlation between positive CCT scans and S-100b was evaluated.

Results: Between January and November 2005, in 168 patients the serum concentration of S-100b was measured. The median age was 8 years (ranging from 2 months to 18 years). The prevalence was higher in boys (113) compared to girls (55). 48 patients (28%) underwent CCT-scans due to ongoing neurological symptoms. In 25 of these patients (52%), scans revealed intracranial pathologies (haemorrhage, fractures, epi-, subdural haematoma). All of these had S-100b serum levels above 0.1 µg/l (mean 1.393, median 0.342) corresponding the adult cut-off value. 17 patients showed elevated S-100b levels despite negative CCT-scans, while in the remaining 6 cases the S-100b was also negative.

Conclusions: The preliminary results show the diagnostic value of S-100b as a marker of neuronal damage after traumatic brain injury in children in correlation with CT scans. Further studies are necessary to evaluate whether S-100b could be helpful for determining the appropriate use of radiological examinations, and to optimize the treatment of head trauma in paediatric patients in the future.