Diagnostic performance of S100B assay for intracranial hemorrhage detection in patients with mild traumatic brain injury under antiplatelet or anticoagulant therapy.

Abstract

The sampling of S100B protein has been proposed as a screening tool to identify patients with a low risk of post-traumatic intracranial hemorrhage. Its performance for patients on antiplatelet agents or anticoagulants is still debatable. This exploratory study evaluates the diagnostic accuracy of S100B concentrations, measured within 3 h of head trauma, to rule out intracranial hemorrhage in adults on antiplatelet or anticoagulant therapy. This prospective study enrolled adult patients presenting for head trauma within the last 3 h and under antiplatelets or anticoagulants. We hypothesized that a S100B concentration under 0,100 µg.L^-1 rule out intracranial hemorrhage with a negative predictive value over 0,99. Sensitivity, specificity, positive predictive value and negative predictive value were analyzed. From June 2020 to January 2023, 155 patients were included. 119 patients had a S100B level at 0,100 µg.L^-1 or over. 8 had an intracranial hemorrhage. The sensitivity of S100B was 1 (95%CI 0,68-1), specificity was 0,25 (95%CI 0,18 - 0,32), positive predictive value was 0,07 (95%CI 0.03-0.13), negative predictive value was 1 (95%CI 0,90 - 1). This study suggests that when performed in a 3-hour period after mild head trauma, S100B measurement is an accurate screening tool to rule out intracranial hemorrhage in patients treated with antiplatelet agents or anticoagulants.