Klinisk Biokemi i Norden · 2 2015
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a blood sample within the first 6 hours, a CT scan
should be performed as the primary screening pro-
cedure instead.
Experience so far with the new guidelines
The new guidelines have now been used for some
months and some experience has been gathered, a
few examples are given below.
Some hospitals have performed S100B analyses
also in patients where the guidelines do
not
recom-
mend it, with the justification “we want to get some
experience with the method”. The reports we have
received from these hospitals so far indicate that
this approach turns out to be more confusing than
clarifying for the involved health personnel, as they
get too many false positive results, with no findings
on the subsequent CT scan. We therefore strongly
recommend that the hospitals stick to the recom-
mendations given in the guidelines: S100B analyses
should replace CT scanning
only for patients in the
“mild injury low-risk” group and only when they have
no overt extra-cranial tissue damage.
Another experience, especially from large hospi-
tals with long distances from the emergency room
to the laboratory, is that it takes too long time to
get the result of the analysis, mainly because of pro-
longed transportation time. This logistical problem
quite often then causes the doctor in charge, who
doesn’t have time to wait for the result, to have a CT
scan of the patient performed instead. It is therefore
important that in-hospital routines allow a quick and
efficient response time.
In a few large university hospitals, the new gui-
delines have seemed to function very well. Analysis
of the S100B patients has shown a CT reduction of
approximately 40% without missing any clinical
complications.
In conclusion we recommend that S100B is used
for patients with
mild injury/low-risk head injury
as a
rule out test to reduce the number of CTs. Many head
injuries occur during weekends or evenings/nights. It
is thus important that the tests are available around
the clock with short test turnaround time We encou-
rage the Scandinavian emergency units and hospital
laboratories to work together to find solutions that
allow S100B testing with short test turnaround times
as part of the head trauma patients care.
References
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