{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:05:25Z","timestamp":1785819925458,"version":"3.56.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Cranial CT (CCT) scans and hospital admission are increasingly performed to rule out intracranial hemorrhage in patients after minor head injury (MHI), particularly in older patients and in those receiving antiplatelet therapy. This leads to high radiation exposure and a growing financial burden. The aim of this study was to determine whether the astroglial-derived protein S100B that is released into blood can be used as a reliable negative predictive tool for intracranial bleeding in patients after MHI, when they are older than 65 years or being treated with antiplatelet drugs (low-dose aspirin, clopidogrel).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors conducted a prospective observational study in 2 trauma hospitals. A total of 782 patients with MHI (Glasgow Coma Scale Score 13\u201315) who were on medication with platelet aggregation inhibitors (PAIs) or were age 65 years and older, independent of antiplatelet therapy, were included. Clinical examination, bloodwork, observation, and CCT were performed in the traumatology emergency departments. When necessary, patients were admitted and observation took place on the ward; in these patients, CCT was performed during their hospital stay. Patients with severe trauma, focal neurological deficits, posttraumatic seizures, anticoagulant therapy, alcohol intoxication, coagulation disorder, blood sampling more than 3 hours after trauma, and unknown time of the trauma were excluded from the study. The median age of the patients was 83 years, and 69% were female. Sensitivity, specificity, and positive and negative predictive values of S100B with reference to CCT findings were calculated. The cutoff of S100B was set at 0.105 \u03bcg\/L.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of the 782 patients, 50 (6.4%) had intracranial bleeding. One patient with positive results on CCT scan showed an S100B level below 0.105 \u03bcg\/L. Of all patients, 33.1% were below the cutoff. S100B showed a sensitivity of 98.0% (CI 89.5%\u201399.7%), a negative predictive value of 99.6% (CI 97.9%\u201399.9%), a specificity of 35.3% (CI 31.9%\u2013 38.8%), and a positive predictive value of 9.4% (CI 7.2%\u201312.2%).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Levels of S100B below 0.105 \u03bcg\/L can accurately predict normal CCT findings after MHI in older patients and in those treated with PAIs. Combining conventional decision criteria with measurement of S100B can reduce the CCT scan and hospital admission rates by approximately 30%.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.12.jns142276","type":"journal-article","created":{"date-parts":[[2015,7,7]],"date-time":"2015-07-07T08:02:18Z","timestamp":1436256138000},"page":"1202-1208","source":"Crossref","is-referenced-by-count":31,"title":["Evaluation of S100B in the diagnosis of suspected intracranial hemorrhage after minor head injury in patients who are receiving platelet aggregation inhibitors and in patients 65 years of age and older"],"prefix":"10.3171","volume":"123","author":[{"given":"Heinrich Wolfgang","family":"Thaler","sequence":"first","affiliation":[{"name":"Trauma Hospital Meidling;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Schmidsfeld","sequence":"additional","affiliation":[{"name":"Department of Traumatology, Donauspital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pusch","sequence":"additional","affiliation":[{"name":"Trauma Hospital Meidling;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Pienaar","sequence":"additional","affiliation":[{"name":"Trauma Hospital Meidling;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Wunderer","sequence":"additional","affiliation":[{"name":"Trauma Hospital Meidling;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Pittermann","sequence":"additional","affiliation":[{"name":"Trauma Hospital Meidling;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosmarie","family":"Valenta","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kaiser-Franz-Josef-Spital, Vienna; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Gleiss","sequence":"additional","affiliation":[{"name":"Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Fialka","sequence":"additional","affiliation":[{"name":"Trauma Hospital Meidling;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Mousavi","sequence":"additional","affiliation":[{"name":"Department of Traumatology, Donauspital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns142276","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s00701-003-0115-1","article-title":"Mild head injury - mortality and complication rate: meta-analysis of findings in a systematic literature review","volume":"145","author":"af Geijerstam","year":"2003"},{"key":"b2-jns142276","series-title":"Shock","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1097\/01.shk.0000209534.61058.35","article-title":"Serum S-100B concentration provides additional information for the indication of computed tomography in patients after minor head injury: a prospective multicenter study","volume":"25","author":"Biberthaler","year":"2006"},{"key":"b3-jns142276","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"2277","DOI":"10.1056\/NEJMra072149","article-title":"Computed tomography\u2014an increasing source of radiation exposure","volume":"357","author":"Brenner","year":"2007"},{"key":"b4-jns142276","series-title":"AJNR Am J Neuroradiol","first-page":"1619","article-title":"Head trauma","volume":"28","author":"Davis","year":"2007"},{"key":"b5-jns142276","series-title":"An Introduction to the Bootstrap","author":"Efron","year":"1993"},{"key":"b6-jns142276","series-title":"Crit Care","doi-asserted-by":"publisher","first-page":"R53","DOI":"10.1186\/cc12575","article-title":"Antiplatelet therapy and the outcome of subjects with intracranial injury: the Italian SIMEU study","volume":"17","author":"Fabbri","year":"2013"},{"key":"b7-jns142276","series-title":"J Trauma","first-page":"245","article-title":"Clinical decision rules for adults with minor head injury: a systematic review","volume":"71","author":"Harnan","year":"2011"},{"key":"b8-jns142276","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1089\/neu.2010.1488","article-title":"Rapid increase in hospitalizations resulting from fall-related traumatic head injury in older adults in The Netherlands 1986\u20132008","volume":"28","author":"Hartholt","year":"2011"},{"key":"b9-jns142276","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1056\/NEJM200007133430204","article-title":"Indications for computed tomography in patients with minor head injury","volume":"343","author":"Haydel","year":"2000"},{"key":"b10-jns142276","series-title":"Biostatistics","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1093\/biostatistics\/kxr020","article-title":"A robust method using propensity score stratification for correcting verification bias for binary tests","volume":"13","author":"He","year":"2012"},{"key":"b11-jns142276","series-title":"J Rehabil Med","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1080\/16501970510027321","article-title":"Summary of the WHO Collaborating Centre for Neurotrauma Task Force on Mild Traumatic Brain Injury","volume":"37","author":"Holm","year":"2005"},{"key":"b12-jns142276","series-title":"Brain Inj","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1080\/02699050050203540","article-title":"The clinical value of serum S-100 protein measurements in minor head injury: a Scandinavian multicentre study","volume":"14","author":"Ingebrigtsen","year":"2000"},{"key":"b13-jns142276","series-title":"Ann Emerg Med","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/j.annemergmed.2008.08.021","article-title":"Clinical policy: neuroimaging and decision making in adult mild traumatic brain injury in the acute setting","volume":"52","author":"Jagoda","year":"2008"},{"key":"b14-jns142276","series-title":"Clin Chem Lab Med","first-page":"527","article-title":"S100B blood level measurement to exclude cerebral lesions after minor head injury: the multicenter STIC-S100 French study","volume":"52","author":"Laribi","year":"2014"},{"key":"b15-jns142276","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1097\/00005373-200210000-00008","article-title":"Intracranial complications of preinjury anticoagulation in trauma patients with head injury","volume":"53","author":"Mina","year":"2002"},{"key":"b16-jns142276","series-title":"Ann Emerg Med","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.annemergmed.2011.12.026","article-title":"Head computed tomography use in the emergency department for mild traumatic brain injury: integrating evidence into practice for the resident physician","volume":"60","author":"Morton","year":"2012"},{"key":"b17-jns142276","series-title":"J Trauma","first-page":"1452","article-title":"S100B serum level predicts computed tomography findings after minor head injury","volume":"62","author":"M\u00fcller","year":"2007"},{"key":"b18-jns142276","series-title":"Health Technol Assess","first-page":"1","article-title":"Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation","volume":"15","author":"Pandor","year":"2011"},{"issue":"6 Suppl","key":"b19-jns142276","series-title":"Chest","doi-asserted-by":"publisher","first-page":"199S","DOI":"10.1378\/chest.08-0672","article-title":"Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition)","volume":"133","author":"Patrono","year":"2008"},{"key":"b20-jns142276","series-title":"J Trauma","first-page":"1600","article-title":"Delayed intracranial hemorrhage after blunt trauma: are patients on preinjury anticoagulants and prescription antiplatelet agents at risk?","volume":"71","author":"Peck","year":"2011"},{"key":"b21-jns142276","series-title":"Microsc Res Tech","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1002\/jemt.10303","article-title":"S100B in brain damage and neurodegeneration","volume":"60","author":"Rothermundt","year":"2003"},{"key":"b22-jns142276","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1097\/00005373-199810000-00025","article-title":"S-100 serum levels after minor and major head injury","volume":"45","author":"Rothoerl","year":"1998"},{"key":"b23-jns142276","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"985","DOI":"10.2214\/AJR.11.6976","article-title":"Falls, older adults, and the trend in utilization of CT in a level I trauma center","volume":"198","author":"Roudsari","year":"2012"},{"key":"b24-jns142276","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1089\/neu.2009.0928","article-title":"The economic impact of S-100B as a pre-head CT screening test on emergency department management of adult patients with mild traumatic brain injury","volume":"26","author":"Ruan","year":"2009"},{"key":"b25-jns142276","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1056\/NEJMp1002530","article-title":"Is computed tomography safe?","volume":"363","author":"Smith-Bindman","year":"2010"},{"key":"b26-jns142276","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"661","DOI":"10.3171\/jns.2003.99.4.0661","article-title":"Low-dose aspirin prophylaxis and risk of intracranial hemorrhage in patients older than 60 years of age with mild or moderate head injury: a prospective study","volume":"99","author":"Spektor","year":"2003"},{"key":"b27-jns142276","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/S0140-6736(00)04561-X","article-title":"The Canadian CT Head Rule for patients with minor head injury","volume":"357","author":"Stiell","year":"2001"},{"key":"b28-jns142276","series-title":"J Trauma","first-page":"521","article-title":"Secondary intracranial hemorrhage after mild head injury in patients with low-dose acetylsalicylate acid prophylaxis","volume":"67","author":"Tauber","year":"2009"},{"key":"b29-jns142276","series-title":"Lancet","first-page":"81","article-title":"Assessment of coma and impaired consciousness. A practical scale","volume":"2","author":"Teasdale","year":"1974"},{"key":"b30-jns142276","series-title":"J Am Geriatr Soc","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1111\/j.1532-5415.2006.00894.x","article-title":"Traumatic brain injury in older adults: epidemiology, outcomes, and future implications","volume":"54","author":"Thompson","year":"2006"},{"key":"b31-jns142276","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1089\/neu.2006.23.149","article-title":"Rapid elimination of protein S-100B from serum after minor head trauma","volume":"23","author":"Townend","year":"2006"},{"key":"b32-jns142276","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1136\/jnnp.73.5.542","article-title":"Head injury outcome prediction in the emergency department: a role for protein S-100B?","volume":"73","author":"Townend","year":"2002"},{"key":"b33-jns142276","series-title":"BMC Med","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/1741-7015-11-50","article-title":"Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: an evidence and consensus-based update","volume":"11","author":"Und\u00e9n","year":"2013"},{"key":"b34-jns142276","series-title":"J Head Trauma Rehabil","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1097\/HTR.0b013e3181e57e22","article-title":"Can low serum levels of S100B predict normal CT findings after minor head injury in adults?: an evidence-based review and meta-analysis","volume":"25","author":"Und\u00e9n","year":"2010"},{"key":"b35-jns142276","series-title":"Am J Cardiol","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.amjcard.2013.03.022","article-title":"Relation of aspirin response to age in patients with stable coronary artery disease","volume":"112","author":"Vaturi","year":"2013"},{"key":"b36-jns142276","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1227\/00006123-199009000-00014","article-title":"Mild head injury classification","volume":"27","author":"Williams","year":"1990"},{"key":"b37-jns142276","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"626","DOI":"10.2214\/AJR.12.9652","article-title":"The risk of cataract associated with repeated head and neck CT studies: a nationwide population-based study","volume":"201","author":"Yuan","year":"2013"},{"key":"b38-jns142276","series-title":"Ann Emerg Med","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.annemergmed.2011.07.027","article-title":"S100-B protein as a screening tool for the early assessment of minor head injury","volume":"59","author":"Zongo","year":"2012"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/123\/5\/article-p1202.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/123\/5\/article-p1202.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/123\/5\/article-p1202.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T21:27:44Z","timestamp":1658698064000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/123\/5\/article-p1202.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11]]},"references-count":38,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2014.12.jns142276","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11]]}}}