{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:57:58Z","timestamp":1791932278981,"version":"4.3.4"},"reference-count":36,"publisher":"Walter de Gruyter GmbH","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_cclm-2020-1293_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-1293_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15\u00a0years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013\u20132014) and after (2014\u20132015) implementation of a modified PECARN rule including the S100B protein assay.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-1293_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We included 1,062 children with mTBI (median age 4.5\u00a0years, sex ratio [F\/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013\u20132014 and 568 (53.5%) during 2014\u20132015. During 2014\u20132015, S100B protein was measured in 451 (79.4%) children within 6\u00a0h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9\u201340.5% (p&lt;0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013\u20132014 and 2014\u20132015. All children with ciTBI were identified by the rules.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-1293_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/cclm-2020-1293","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T21:19:26Z","timestamp":1606771166000},"page":"875-882","source":"Crossref","is-referenced-by-count":12,"title":["Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury"],"prefix":"10.1515","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0921-4622","authenticated-orcid":false,"given":"Fleur","family":"Lorton","sequence":"first","affiliation":[{"name":"Clinical Investigation Centre , Inserm 1413, University Hospital , Nantes , France"},{"name":"Department of Pediatrics and Pediatric Emergency , University Hospital , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne","family":"Simon-Pimmel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Pediatric Emergency , University Hospital , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Masson","sequence":"additional","affiliation":[{"name":"Biochemistry Department , University Hospital , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Launay","sequence":"additional","affiliation":[{"name":"Clinical Investigation Centre , Inserm 1413, University Hospital , Nantes , France"},{"name":"Department of Pediatrics and Pediatric Emergency , University Hospital , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christ\u00e8le","family":"Gras-Le Guen","sequence":"additional","affiliation":[{"name":"Clinical Investigation Centre , Inserm 1413, University Hospital , Nantes , France"},{"name":"Department of Pediatrics and Pediatric Emergency , University Hospital , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Scherdel","sequence":"additional","affiliation":[{"name":"Clinical Investigation Centre , Inserm 1413, University Hospital , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2020,11,25]]},"reference":[{"key":"2023033113430159555_j_cclm-2020-1293_ref_001","doi-asserted-by":"crossref","unstructured":"Lumba-Brown, A, Yeates, KO, Sarmiento, K, Breiding, MJ, Haegerich, TM, Gioia, GA, et al.. Centers for disease control and prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr 2018;172:e182853. https:\/\/doi.org\/10.1001\/jamapediatrics.2018.2853.","DOI":"10.1001\/jamapediatrics.2018.2853"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_002","doi-asserted-by":"crossref","unstructured":"Pandor, A, Goodacre, S, Harnan, S, Holmes, M, Pickering, A, Fitzgerald, P, et al.. Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation. Health Technol Assess 2011;15:1\u2013202. https:\/\/doi.org\/10.3310\/hta15270.","DOI":"10.3310\/hta15270"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_003","doi-asserted-by":"crossref","unstructured":"Atabaki, SM, Hoyle, JD, Schunk, JE, Monroe, DJ, Alpern, ER, Quayle, KS, et al.. Comparison of prediction rules and clinician suspicion for identifying children with clinically important brain injuries after blunt head trauma. Acad Emerg Med 2016;23:566\u201375. https:\/\/doi.org\/10.1111\/acem.12923.","DOI":"10.1111\/acem.12923"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_004","doi-asserted-by":"crossref","unstructured":"Pearce, MS, Salotti, JA, Little, MP, McHugh, K, Lee, C, Kim, KP, et al.. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012;380:499\u2013505. https:\/\/doi.org\/10.1016\/s0140-6736(12)60815-0.","DOI":"10.1016\/S0140-6736(12)60815-0"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_005","doi-asserted-by":"crossref","unstructured":"Miglioretti, DL, Johnson, E, Williams, A, Greenlee, RT, Weinmann, S, Solberg, LI, et al.. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013;167:700\u20137. https:\/\/doi.org\/10.1001\/jamapediatrics.2013.311.","DOI":"10.1001\/jamapediatrics.2013.311"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_006","unstructured":"Report to congress: the management of traumatic brain injury in children: opportunities for action. Available from: https:\/\/www.cdc.gov\/traumaticbraininjury\/pdf\/reportstocongress\/managementoftbiinchildren\/TBI-ReporttoCongress-508.pdf [Accessed June 2020]."},{"key":"2023033113430159555_j_cclm-2020-1293_ref_007","doi-asserted-by":"crossref","unstructured":"Kuppermann, N, Holmes, JF, Dayan, PS, Hoyle, JD, Atabaki, SM, Holubkov, R, et al.. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009;374:1160\u201370. https:\/\/doi.org\/10.1016\/s0140-6736(09)61558-0.","DOI":"10.1016\/S0140-6736(09)61558-0"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_008","doi-asserted-by":"crossref","unstructured":"Schonfeld, D, Bressan, S, Da Dalt, L, Henien, MN, Winnett, JA, Nigrovic, LE. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child 2014;99:427\u201331. https:\/\/doi.org\/10.1136\/archdischild-2013-305004.","DOI":"10.1136\/archdischild-2013-305004"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_009","doi-asserted-by":"crossref","unstructured":"Babl, FE, Borland, ML, Phillips, N, Kochar, A, Dalton, S, McCaskill, M, et al.. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet 2017;389:2393\u2013402. https:\/\/doi.org\/10.1016\/s0140-6736(17)30555-x.","DOI":"10.1016\/S0140-6736(17)30555-X"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_010","doi-asserted-by":"crossref","unstructured":"Lorton, F, Poullaouec, C, Legallais, E, Simon-Pimmel, J, Ch\u00eane, MA, Leroy, H, et al.. Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study. Scand J Trauma Resuscitation Emerg Med 2016;24:98. https:\/\/doi.org\/10.1186\/s13049-016-0287-3.","DOI":"10.1186\/s13049-016-0287-3"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_011","doi-asserted-by":"crossref","unstructured":"Pickering, A, Harnan, S, Fitzgerald, P, Pandor, A, Goodacre, S. Clinical decision rules for children with minor head injury: a systematic review. Arch Dis Child 2011;96:414\u201321. https:\/\/doi.org\/10.1136\/adc.2010.202820.","DOI":"10.1136\/adc.2010.202820"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_012","doi-asserted-by":"crossref","unstructured":"Bressan, S, Romanato, S, Mion, T, Zanconato, S, Da Dalt, L. Implementation of adapted PECARN decision rule for children with minor head injury in the pediatric emergency department. Acad Emerg Med 2012;19:801\u20137. https:\/\/doi.org\/10.1111\/j.1553-2712.2012.01384.x.","DOI":"10.1111\/j.1553-2712.2012.01384.x"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_013","doi-asserted-by":"crossref","unstructured":"Hess, EP, Homme, JL, Kharbanda, AB, Tzimenatos, L, Louie, JP, Cohen, DM, et al.. Effect of the head computed tomography choice decision aid in parents of children with minor head trauma: a cluster randomized trial. JAMA Netw Open 2018;1:e182430. https:\/\/doi.org\/10.1001\/jamanetworkopen.2018.2430.","DOI":"10.1001\/jamanetworkopen.2018.2430"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_014","doi-asserted-by":"crossref","unstructured":"Nigrovic, LE, Kuppermann, N. Children with minor blunt head trauma presenting to the emergency department. Pediatrics 2019;144. https:\/\/doi.org\/10.1542\/peds.2019-1495.","DOI":"10.1542\/peds.2019-1495"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_015","doi-asserted-by":"crossref","unstructured":"Romner, B, Ingebrigtsen, T, Kongstad, P, B\u00f8rgesen, SE. Traumatic brain damage: serum S-100 protein measurements related to neuroradiological findings. J Neurotrauma 2000;17:641\u20137. https:\/\/doi.org\/10.1089\/089771500415391.","DOI":"10.1089\/089771500415391"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_016","doi-asserted-by":"crossref","unstructured":"Peskind, ER, Griffin, WS, Akama, KT, Raskind, MA, Van Eldik, LJ. Cerebrospinal fluid S100B is elevated in the earlier stages of Alzheimer\u2019s disease. Neurochem Int 2001;39:409\u201313. https:\/\/doi.org\/10.1016\/s0197-0186(01)00048-1.","DOI":"10.1016\/S0197-0186(01)00048-1"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_017","doi-asserted-by":"crossref","unstructured":"Herrmann, M, Vos, P, Wunderlich, MT, de Bruijn, CH, Lamers, KJ. Release of glial tissue-specific proteins after acute stroke: a comparative analysis of serum concentrations of protein S-100B and glial fibrillary acidic protein. Stroke 2000;31:2670\u20137. https:\/\/doi.org\/10.1161\/01.str.31.11.2670.","DOI":"10.1161\/01.STR.31.11.2670"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_018","doi-asserted-by":"crossref","unstructured":"Biberthaler, P, Linsenmeier, U, Pfeifer, K-J, Kroetz, M, Mussack, T, Kanz, K-G, et al.. Serum S-100B concentration provides additional information for the indication of computed tomography in patients after minor head injury: a prospective multicenter study. Shock 2006;25:446\u201353. https:\/\/doi.org\/10.1097\/01.shk.0000209534.61058.35.","DOI":"10.1097\/01.shk.0000209534.61058.35"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_019","doi-asserted-by":"crossref","unstructured":"M\u00fcller, K, Townend, W, Biasca, N, Und\u00e9n, J, Waterloo, K, Romner, B, et al.. S100B serum level predicts computed tomography findings after minor head injury. J Trauma 2007;62:1452\u20136. https:\/\/doi.org\/10.1097\/ta.0b013e318047bfaa.","DOI":"10.1097\/TA.0b013e318047bfaa"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_020","doi-asserted-by":"crossref","unstructured":"Und\u00e9n, J, Romner, B. Can low serum levels of S100B predict normal CT findings after minor head injury in adults? an evidence-based review and meta-analysis. J Head Trauma Rehabil 2010;25:228\u201340. https:\/\/doi.org\/10.1097\/htr.0b013e3181e57e22.","DOI":"10.1097\/HTR.0b013e3181e57e22"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_021","doi-asserted-by":"crossref","unstructured":"Bechtel, K, Frasure, S, Marshall, C, Dziura, J, Simpson, C. Relationship of serum S100B levels and intracranial injury in children with closed head trauma. Pediatrics 2009;124:e697\u2013704. https:\/\/doi.org\/10.1542\/peds.2008-1493.","DOI":"10.1542\/peds.2008-1493"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_022","doi-asserted-by":"crossref","unstructured":"Oris, C, Pereira, B, Durif, J, Simon-Pimmel, J, Castellani, C, Manzano, S, et al.. The biomarker S100B and mild traumatic brain injury: a meta-analysis. Pediatrics 2018;141. https:\/\/doi.org\/10.1542\/peds.2018-0037.","DOI":"10.1542\/peds.2018-0037"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_023","doi-asserted-by":"crossref","unstructured":"Simon-Pimmel, J, Lorton, F, Guiziou, N, Levieux, K, Vrignaud, B, Masson, D, et al.. Serum S100\u03b2 neuroprotein reduces use of cranial computed tomography in children after minor head trauma. Shock 2015;44:410\u20136. https:\/\/doi.org\/10.1097\/shk.0000000000000442.","DOI":"10.1097\/SHK.0000000000000442"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_024","doi-asserted-by":"crossref","unstructured":"Bouvier, D, Fournier, M, Dauphin, J-B, Amat, F, Ughetto, S, Labb\u00e9, A, et al.. Serum S100B determination in the management of pediatric mild traumatic brain injury. Clin Chem 2012;58:1116\u201322. https:\/\/doi.org\/10.1373\/clinchem.2011.180828.","DOI":"10.1373\/clinchem.2011.180828"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_025","doi-asserted-by":"crossref","unstructured":"Mannix, R, Levy, R, Zemek, R, Yeates, KO, Arbogast, K, Meehan, WP, et al.. Fluid biomarkers of pediatric mild traumatic brain injury: a systematic review. J Neurotrauma 2020. https:\/\/doi.org\/10.1089\/neu.2019.6956.","DOI":"10.1089\/neu.2019.6956"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_026","unstructured":"International statistical classification of diseases and related health problems 10th revision. Available from: https:\/\/icd.who.int\/browse10\/2015\/en#\/ [Accessed June 2020]."},{"key":"2023033113430159555_j_cclm-2020-1293_ref_027","doi-asserted-by":"crossref","unstructured":"Bouvier, D, Castellani, C, Fournier, M, Dauphin, J-B, Ughetto, S, Breton, M, et al.. Reference ranges for serum S100B protein\u00a0during the first three years of life. Clin Biochem 2011;44:927\u20139. https:\/\/doi.org\/10.1016\/j.clinbiochem.2011.05.004.","DOI":"10.1016\/j.clinbiochem.2011.05.004"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_028","doi-asserted-by":"crossref","unstructured":"Lorton, F, Levieux, K, Vrignaud, B, Hamel, O, Jehl\u00e9, E, Hamel, A, et al.. New recommendations for the management of children after minor head trauma. Arch Pediatr 2014;21:790\u20136. https:\/\/doi.org\/10.1016\/j.arcped.2014.04.015.","DOI":"10.1016\/j.arcped.2014.04.015"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_029","doi-asserted-by":"crossref","unstructured":"Mower, WR. Paediatric head imaging decisions are not child\u2019s play. Lancet 2017;389:2354\u20135. https:\/\/doi.org\/10.1016\/s0140-6736(17)30932-7.","DOI":"10.1016\/S0140-6736(17)30932-7"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_030","doi-asserted-by":"crossref","unstructured":"Kemp, A, Nickerson, E, Trefan, L, Houston, R, Hyde, P, Pearson, G, et al.. Selecting children for head CT following head injury. Arch Dis Child 2016;101:929\u201334. https:\/\/doi.org\/10.1136\/archdischild-2015-309078.","DOI":"10.1136\/archdischild-2015-309078"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_031","doi-asserted-by":"crossref","unstructured":"Burstein, B, Upton, JEM, Terra, HF, Neuman, MI. Use of CT for head trauma: 2007-2015. Pediatrics 2018;142. https:\/\/doi.org\/10.1542\/peds.2018-0814.","DOI":"10.1542\/peds.2018-0814"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_032","unstructured":"Ide, K, Uematsu, S, Hayano, S, Hagiwara, Y, Tetsuhara, K, Ito, T, et al.. Validation of the PECARN head trauma prediction rules in Japan: a multicenter prospective study. Am J Emerg Med 2019;S0735-6757:30588\u20131."},{"key":"2023033113430159555_j_cclm-2020-1293_ref_033","doi-asserted-by":"crossref","unstructured":"`Ananthaharan, A, Kravdal, G, Straume-Naesheim, TM. Utility and\u00a0effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain\u00a0injury - a prospective cohort study. BMC Emerg Med 2018;18:44. https:\/\/doi.org\/10.1186\/s12873-018-0193-2.","DOI":"10.1186\/s12873-018-0193-2"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_034","doi-asserted-by":"crossref","unstructured":"JJS, Rickard, Di-Pietro, V, Smith, DJ, Davies, DJ, Belli, A, Goldberg Oppenheimer, P. Rapid optofluidic detection of biomarkers for traumatic brain injury via surface-enhanced Raman spectroscopy. Nat Biomed Eng 2020. https:\/\/doi.org\/10.1038\/s41551-019-0510-4.","DOI":"10.1038\/s41551-019-0510-4"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_035","doi-asserted-by":"crossref","unstructured":"Yue, JK, Yuh, EL, Korley, FK, Winkler, EA, Sun, X, Puffer, RC, et al.. Association between plasma GFAP concentrations and MRI abnormalities in patients with CT-negative traumatic brain injury in the TRACK-TBI cohort: a prospective multicentre study. Lancet Neurol 2019;18:953\u201361. https:\/\/doi.org\/10.1016\/s1474-4422(19)30282-0.","DOI":"10.1016\/S1474-4422(19)30282-0"},{"key":"2023033113430159555_j_cclm-2020-1293_ref_036","doi-asserted-by":"crossref","unstructured":"Simon-Pimmel, J, Lorton, F, Masson, D, Bouvier, D, Hanf, M, Gras-Le Guen, C. Reference ranges for serum S100B neuroprotein specific to infants under four months of age. Clin Biochem 2017;50:1056\u201360. https:\/\/doi.org\/10.1016\/j.clinbiochem.2017.08.014.","DOI":"10.1016\/j.clinbiochem.2017.08.014"}],"container-title":["Clinical Chemistry and Laboratory Medicine (CCLM)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/view\/journals\/cclm\/ahead-of-print\/article-10.1515-cclm-2020-1293\/article-10.1515-cclm-2020-1293.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/cclm-2020-1293\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/cclm-2020-1293\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T19:18:16Z","timestamp":1680290296000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/cclm-2020-1293\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,25]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,12,4]]},"published-print":{"date-parts":[[2021,4,27]]}},"alternative-id":["10.1515\/cclm-2020-1293"],"URL":"https:\/\/doi.org\/10.1515\/cclm-2020-1293","relation":{},"ISSN":["1434-6621","1437-4331"],"issn-type":[{"value":"1434-6621","type":"print"},{"value":"1437-4331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,25]]}}}