Recommendation ID
CG175/3
Question
Using biomarkers to diagnose brain injury:- In adults with medium risk indications for brain injury under the 2014 NICE CT head injury guidance, what is the clinical and cost effectiveness of using the diagnostic circulating biomarker S100B to rule out significant intracranial injury?
Any explanatory notes
(if applicable)
Why this is important:- Circulating biomarkers, if validated, could provide a convenient and clinically applicable aid to the diagnosis of mild traumatic brain injury (TBI) – a 'troponin for the brain'. If such biomarkers were sufficiently sensitive as well as specific for injury type (separating patients with traumatic axonal injury (TAI) from those with contusions), panels of biomarkers might not only help to determine which patients need neuroimaging but also allow us to devise rational, cost-effective pathways for neuroimaging – perhaps reserving primary use of advanced MRI for patients who have TAI as these lesions are undetectable on CT head scans. In addition, the availability of quantifiable biomarkers, scaled with the severity of injury, could help clinicians monitor the progression of brain injury in patients with more severe TBI, help stratify patients for trials and therapies, and provide significant prognostic information across all severities of TBI.
There is low-quality clinical effectiveness data for using the biomarker S100B to rule out significant intracranial injury in patients in the emergency department. Current evidence suggests that there is variation in the use of biomarker tests, including in the timing of testing, the concentration of biomarker used as a diagnostic cut-off, protocols used for sample transport and storage, and the equipment used for biomarker assays in laboratories. A diagnostic study (using randomised or consecutively selected patients) is needed to investigate the role of S100B in patients with selected head injury patterns.
The GDG also recognised the potential utility use of near-patient testing for biomarker tests to reduce the time from injury and blood sampling to test results. In addition, the GDG would welcome an additional outcome of 3-month follow-up of functional outcome/post-concussion symptoms alongside this study with appropriate economic evaluation. This research would provide UK-based evidence as to the potential benefit of biomarkers and any associated reduction in CT head scans and hospital admissions.

Source guidance details

Comes from guidance
Prostate cancer: diagnosis and management
Number
CG175
Date issued
January 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 28/02/2014