Neuron-specific enolase and protein S-100 B as prognostic parameters for children with head injury
KeywordsHead Injury Schwann Cell Glasgow Coma Scale Neuroendocrine Cell Prognostic Parameter
Neuron-specific enolase (NSE) (glycolytic enzyme in neurons and neuroendocrine cells) and protein S-100 B (calcium2+-binding protein in astroglial and Schwann cells) are established neurobiochemical markers that can be used for evaluating the severity of organic brain damage. The examination of these parameters in serum was used to show the practical relevance in correlation with further examination criteria (Glasgow Coma Scale [GCS], outcome, hospital treatment and ventilation time).
Patients and methods
Thirty-nine boys and 16 girls aged 8 ± 4.7 years (range 2 months–16 years) suffering from light to severe head injury (49.1% traffic accident, 38.2% falls, 3.6% child abuse, 3.6% riding accidents, 5.5% other accidents) were included in the study. The examinations of NSE (reference <12 μg/l) and protein S-100 B from the serum were performed using the Liason® Analyser from Byk Sangtec and reagents from Diasorin. Both markers were identified using an immunoluminometric assay (sandwich test). For 52 patients NSE was measured and for 30 patients protein S-100 B was additionally detected after a maximum of 12 hours after the trauma. The correlative behaviour of both parameters towards each other, towards the sex of the patients, the GCS groups (group 1: 4–8 points, group 2: 9–12 points, group 3: >12 points), the hospital treatment time, the ventilation hours and the outcome were tested towards significance (Mann–Whitney test).
Significant correlations for NSE and protein S-100 B were seen for the outcome of patients with head injury. NSE (P < 0.01) and protein S-100 B (P < 0.05) were significantly higher when rehabilitation was necessary or death occurred. Children in need of ventilation had significantly higher NSE (P < 0.01). Protein S-100 B did not behave comparably. Comparing the sex of the patients and the GCS groups, no correlation of the parameters were found. A total of 68.1% of the patients were dismissed home, 20% were transferred to a rehabilitation facility, 12.7% were transferred to another hospital and 5.5% of the patients died.
NSE and protein S-100 B are closely correlated with the severity of traumatic head injuries in childhood and young adolescence. They should thus find more attention as prognostic parameters in the intensive medical treatment of children.