Emergency diagnostics for minor head trauma

For patients with minor head trauma there is the potential danger of intracranial hemorrhaging. However, current guidelines and recommendations incorporate various and divergent criteria for initial assessment and computed tomography. The aim of this study was an assessment of neuroglial protein S100B as a screening test for minor head injuries. A systematic search in Pubmed, MEDLINE and a manual search were carried out to review relevant articles published between January 1997 and August 2010. Keywords were "head trauma", "head injury", "brain trauma" or "brain injury" in combination with "S100B" or "S-100B". We identified 17 relevant articles of which 8 prospective studies with combined 2,082 patients analyzed the possible use of S100B as a screening test for minor head trauma. The interaction between the serum level of protein S100BB and sports activities was analyzed in 7 studies and 2 studies analyzed the prognostic value of S100B for survival in cardiac arrest patients. A cut-off level of 0.1 A mu g/l S100B seemed to be safe enough to exclude a relevant intracranial injury resulting in a 30% reduction of cranial computed tomography (CCT) examinations. For patients with minor head trauma protein S100B is suitable for routine use in emergency departments to rule out intracranial lesions and determine the need for CCT. An algorithm for the use of S100B in emergency departments is presented.