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One-year follow-up of patients with mild traumatic brain injury: occurrence of post-traumatic stress-related symptoms and serum levels of cortisol, S-100B and neuron-specific enolase in acute phase
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
Umeå University, Faculty of Medicine, Department of Medical Biosciences.
2006 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 20, no 6, 613-620 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate serum levels of cortisol (a biochemical marker of stress), S-100B and neuron-specific enolase (two biochemical markers of brain tissue injury), in acute phase in mild traumatic brain injury patients and the occurrence of post-traumatic stress-related symptoms 1 year after the trauma.

METHODS: Blood samples were taken in patients (n = 88) on admission and approximately 7 hours later for analysis. Occurrence of post-traumatic stress-related symptoms was assessed for 69 patients using items from the Impact of Event Scale questionnaire (IES) at follow-up at 15 +/- 4 months after the injury.

RESULTS: Serum levels of cortisol were more increased in the first sample (cortisol/1, 628.9 +/- 308.9 nmol L-1) than in the second blood sample (cortisol/2, 398.2 +/- 219.4 nmol L-1). The difference between these samples was statistically significant (p < 0.001). Altogether 12 patients (17%) showed post-traumatic stress related symptoms at the time of the follow-up. Stepwise forward logistic regression analysis of symptoms and serum concentrations of markers revealed that only S-100B in the second sample was statistically significantly (p < 0.05) associated to symptoms (three symptoms of the avoidance sub-set of IES).

CONCLUSION: A major increase in serum concentrations of cortisol indicates that high stress levels were reached by the patients, in particular shortly ( approximately 3 hours) after the trauma. The association between the occurrence of post-traumatic stress related symptoms and serum levels of S-100B (generally considered as a biochemical marker of brain injury) seem to reflect the complexity of interactions between brain tissue injury and the ensemble of stress reactions.

Place, publisher, year, edition, pages
Taylor & Francis, 2006. Vol. 20, no 6, 613-620 p.
Keyword [en]
traumatic brain injury, head trauma, brain concussion, post-concussion symptoms biochemical marker, S100 proteins, cortisol, post-traumatic stress disorder
National Category
Neurosciences
Identifiers
URN: urn:nbn:se:umu:diva-3928DOI: 10.1080/02699050600676982ISI: 000238947100006PubMedID: 16754286OAI: oai:DiVA.org:umu-3928DiVA: diva2:142840
Available from: 2004-05-05 Created: 2004-05-05 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Detection and outcome of mild traumatic brain injury in patients and sportsmen: persisting symptoms, disabilities and life satisfaction in relation to S-100B, NSE and cortisol
Open this publication in new window or tab >>Detection and outcome of mild traumatic brain injury in patients and sportsmen: persisting symptoms, disabilities and life satisfaction in relation to S-100B, NSE and cortisol
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Traumatic brain injuries are common (hospitalization incidence: 250-300 per 100.000 inhabitants/year) and a great majority of these injuries (80-85%) are classified as mild traumatic brain injury (MTBI/concussion). Many patients with MTBI (20-80%) suffer from subsequent persistent and often disabling symptoms. In previous studies serum levels of biochemical markers of brain tissue damage (S-100B and neuron-specific enolase, NSE) have been propounded to serve as predictors of persisting symptoms.In the present studies serum concentrations of S-100B, NSE and cortisol in acute phase and post-concussion symptoms, post-traumatic stress-related symptoms, disabilities and life satisfaction one year after the trauma, were investigated in 88 patients (53 men and 35 women) with MTBI. Serum concentrations of S-100B and NSE were also assessed in elite players (n=54) of typical contact sports (ice-hockey and soccer), which are known to be high risk activities with respect to head injury. Basketball players (n=18) were used as a control group.

A majority of patients with MTBI showed higher serum concentrations of S-100B, NSE and cortisol on admission compared with a second blood sample obtained about 7 hours later (p<0.001 for all analyses). Sequelae were common one year after the injury. Postconcussion symptoms were encountered in 45 % of the patients, stress-related symptoms in 17 % and disabilities in 48 %, but only 3 patients (4 %) were on sick-leave on follow-up due to the head trauma. There was a statistically significant negative correlation between the total score of life satisfaction and the total score of disability (r= -0.514, p<0.001). Symptoms on admission (dizziness, nausea) and S-100B were statistically significantly associated with disabilities (p<0.024, multiple logistic regression analysis). Nausea on admission was also statistically significantly associated with life satisfaction (p=0.004). A statistically significant association was found only for S-100B with early (0-1 week postinjury, p=0.008) and only for cortisol with late (more than 52 weeks post-injury, p=0.022) post-traumatic stress-related symptoms.

Concentrations of S-100B after game were statistically significantly increased in comparison with the levels before game (soccer, p<0.001; ice-hockey, p<0.001; basketball (p<0.001). Concentrations of NSE were only raised after soccer play (p<0.001). Increases in S-100-B (post-game minus pre-game values) were correlated to the number of jumps in basketball play (r=0.706, p=0.002). For soccer, increases in S-100B were correlated to the number of headers (r=0.428, p=0.02) and to the number of acceleration/deceleration events other than heading (r=0.453, p=0.02).

The findings provide support for the idea that injury of brain tissue is involved in the genesis of persisting disabilities and long-term changes of life satisfaction in MTBI. Since S-100B increases in serum were correlated to the number of headers and since soccer play also increased serum levels of NSE (in contrast to ice hockey and basketball), it seems that heading may have an impact on brain tissue. The studies have also shown that ordinary playing of the team sports in question (i.e. soccer, ice hockey and basketball) increases S-100B serum concentrations, which has to be taken into consideration when S-100B is used for the detection of injury of brain tissue in sportsmen with acute/overt head trauma during sport practice. An analysis of the biochemical markers of brain damage (in particular S-100B) may be an additional source of valuable information in the management of patients and sportsmen with MTBI. S-100B also seems to be promising for the prediction of impairments and disabilities after MTBI.

Place, publisher, year, edition, pages
Umeå: Umeå universitet. Institutionen för samhällsmedicin och rehabilitering, 2004. 64 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 896
Keyword
Medicine, traumatic brain injury, brain concussion, biochemical marker, S100 proteins, cortisol, post concussion symptoms, stress disorder posttraumatic, life satisfaction, sport, Medicin
National Category
Dermatology and Venereal Diseases
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-259 (URN)91-7305-665-0 (ISBN)
Public defence
2004-05-26, Hörsal B, 9tr, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 13:15
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Available from: 2004-05-05 Created: 2004-05-05 Last updated: 2010-08-23Bibliographically approved

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Sojka, PeterStålnacke, Britt-MarieBjörnstig, UlfKarlsson, Kurt
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