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Prospective comparison of capillary and venous brain biomarker S100B : Capillary samples have large inter-sample variation and poor correlation with venous samples

Vedin, Tomas LU ; Karlsson, Mathias ; Edelhamre, Marcus LU ; Bergenheim, Mikael and Larsson, Per Anders LU (2019) In International Journal of Emergency Medicine 12(1).
Abstract

Background: Guidelines for the emergency management of mild traumatic brain injury have been used for over a decade and are considered safe. However, they recommend computerized tomography for at least half of these patients. The Scandinavian Neurotrauma Committee guideline uses serum S100B protein level to rule out intracranial hemorrhage. Analysis of capillary serum S100B protein level has not yet been employed for this purpose. The primary aim of this study was to investigate the correlation and agreement of capillary and venous serum S100B protein level over a spectrum of concentrations typical for mild traumatic brain injury. Methods: Eighteen patients with traumatic intracranial hemorrhage and 39 volunteers without trauma to the... (More)

Background: Guidelines for the emergency management of mild traumatic brain injury have been used for over a decade and are considered safe. However, they recommend computerized tomography for at least half of these patients. The Scandinavian Neurotrauma Committee guideline uses serum S100B protein level to rule out intracranial hemorrhage. Analysis of capillary serum S100B protein level has not yet been employed for this purpose. The primary aim of this study was to investigate the correlation and agreement of capillary and venous serum S100B protein level over a spectrum of concentrations typical for mild traumatic brain injury. Methods: Eighteen patients with traumatic intracranial hemorrhage and 39 volunteers without trauma to the head within the past 7 days were recruited. Blood was sampled from patients with intracranial hemorrhage daily up to four consecutive days and healthy volunteers were sampled once during the study. One venous and two capillary samples were drawn at each sampling event. Samples were analyzed using the Cobas e411 S100 electrochemiluminescence assay. Results: Median serum S100B protein level of capillary sampling 1 was 0.12 (IQR 0.075-0.21) μg/l and median serum S100B protein level of capillary sampling 2 was 0.13 (IQR 0.08-0.22) μg/l. Median serum S100B protein level of all venous samples was 0.05 (IQR 0.03-0.07) μg/l. Correlation plots of capillary and venous samples showed poor correlation and Bland-Altman plots showed a large dispersion of samples and wide limits of agreement. Conclusion: The results of this study indicate that correlation and agreement between capillary and venous samples are low, and because of this, we cannot recommend studies on capillary serum S100B protein level to rule out intracranial hemorrhage in mild traumatic brain injury. Given the limitations of the current sampling and analysis methods of capillary protein S100B protein level, we conclude that evaluating its predictive ability to rule out intracranial hemorrhage should be withheld until more reliable methods can be incorporated into the study design.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood specimen collection, Brain injuries traumatic, Capillary, S100 calcium-binding protein beta subunit, S100B, Venous
in
International Journal of Emergency Medicine
volume
12
issue
1
article number
26
publisher
Springer
external identifiers
  • pmid:31477027
  • scopus:85071863189
ISSN
1865-1372
DOI
10.1186/s12245-019-0239-6
language
English
LU publication?
yes
id
5023750f-710e-4ff9-b828-6ae87fccfb00
date added to LUP
2019-09-17 10:53:40
date last changed
2024-05-29 00:17:12
@article{5023750f-710e-4ff9-b828-6ae87fccfb00,
  abstract     = {{<p>Background: Guidelines for the emergency management of mild traumatic brain injury have been used for over a decade and are considered safe. However, they recommend computerized tomography for at least half of these patients. The Scandinavian Neurotrauma Committee guideline uses serum S100B protein level to rule out intracranial hemorrhage. Analysis of capillary serum S100B protein level has not yet been employed for this purpose. The primary aim of this study was to investigate the correlation and agreement of capillary and venous serum S100B protein level over a spectrum of concentrations typical for mild traumatic brain injury. Methods: Eighteen patients with traumatic intracranial hemorrhage and 39 volunteers without trauma to the head within the past 7 days were recruited. Blood was sampled from patients with intracranial hemorrhage daily up to four consecutive days and healthy volunteers were sampled once during the study. One venous and two capillary samples were drawn at each sampling event. Samples were analyzed using the Cobas e411 S100 electrochemiluminescence assay. Results: Median serum S100B protein level of capillary sampling 1 was 0.12 (IQR 0.075-0.21) μg/l and median serum S100B protein level of capillary sampling 2 was 0.13 (IQR 0.08-0.22) μg/l. Median serum S100B protein level of all venous samples was 0.05 (IQR 0.03-0.07) μg/l. Correlation plots of capillary and venous samples showed poor correlation and Bland-Altman plots showed a large dispersion of samples and wide limits of agreement. Conclusion: The results of this study indicate that correlation and agreement between capillary and venous samples are low, and because of this, we cannot recommend studies on capillary serum S100B protein level to rule out intracranial hemorrhage in mild traumatic brain injury. Given the limitations of the current sampling and analysis methods of capillary protein S100B protein level, we conclude that evaluating its predictive ability to rule out intracranial hemorrhage should be withheld until more reliable methods can be incorporated into the study design.</p>}},
  author       = {{Vedin, Tomas and Karlsson, Mathias and Edelhamre, Marcus and Bergenheim, Mikael and Larsson, Per Anders}},
  issn         = {{1865-1372}},
  keywords     = {{Blood specimen collection; Brain injuries traumatic; Capillary; S100 calcium-binding protein beta subunit; S100B; Venous}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{1}},
  publisher    = {{Springer}},
  series       = {{International Journal of Emergency Medicine}},
  title        = {{Prospective comparison of capillary and venous brain biomarker S100B : Capillary samples have large inter-sample variation and poor correlation with venous samples}},
  url          = {{http://dx.doi.org/10.1186/s12245-019-0239-6}},
  doi          = {{10.1186/s12245-019-0239-6}},
  volume       = {{12}},
  year         = {{2019}},
}