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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
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
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 [en]
Medicine, traumatic brain injury, brain concussion, biochemical marker, S100 proteins, cortisol, post concussion symptoms, stress disorder posttraumatic, life satisfaction, sport
Keyword [sv]
Medicin
National Category
Dermatology and Venereal Diseases
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:umu:diva-259ISBN: 91-7305-665-0 (print)OAI: oai:DiVA.org:umu-259DiVA: diva2:142843
Public defence
2004-05-26, Hörsal B, 9tr, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 13:15
Opponent
Supervisors
Available from: 2004-05-05 Created: 2004-05-05 Last updated: 2010-08-23Bibliographically approved
List of papers
1. One-year follow-up of patients with mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction at follow-up in relation to serum levels of S-100B and neuron-specific enolase in acute phase
Open this publication in new window or tab >>One-year follow-up of patients with mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction at follow-up in relation to serum levels of S-100B and neuron-specific enolase in acute phase
2005 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 37, no 5, 300-305 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate, in patients with mild traumatic brain injury, serum concentrations of S-100B and neurone-specific enolase in acute phase and post-concussion symptoms, disabilities and life satisfaction 1 year after the trauma.

DESIGN: Prospective study.

PATIENTS: Eighty-eight patients (age range 18-87 years).

METHODS: Blood samples were taken on admission and about 7 hours later. At follow-up 15 +/- 4 months later, the patients filled in questionnaires about symptoms (Rivermead Post Concussion Symptoms), disability (Rivermead Head Injury Follow-up) and life satisfaction (LiSat-11).

RESULTS: Concentrations of S-100B and neurone-specific enolase were regularly increased in the first blood sample. Of the 69 patients participating in the follow-up, 45% reported post-concussion symptom, 48% exhibited disability and 55% were satisfied with "life as a whole". In comparison with the "sick-leave" situation on admission to hospital, 3 patients were on sick-leave at the time of follow-up because of the head trauma. Stepwise forward logistic regression analysis revealed a statistically significant association (p<0.05) between disability and S-100B and dizziness.

CONCLUSION: In spite of frequent persistent symptoms, disabilities and low levels of life satisfaction, the sick-leave frequency was low at follow-up. The association between S-100B and disability supports the notion that long-term consequences of a mild brain injury may partly be a result of brain tissue injury.

Place, publisher, year, edition, pages
Taylor & Francis, 2005
Keyword
traumatic brain injury, head trauma, brain concussion, biochemical marker, S-100 proteins, life satisfaction, post-concussion symptoms
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-3927 (URN)10.1080/16501970510032910 (DOI)000232225300005 ()16208863 (PubMedID)
Available from: 2004-05-05 Created: 2004-05-05 Last updated: 2013-10-07Bibliographically approved
2. 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
Open this publication in new window or tab >>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
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
Keyword
traumatic brain injury, head trauma, brain concussion, post-concussion symptoms biochemical marker, S100 proteins, cortisol, post-traumatic stress disorder
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-3928 (URN)10.1080/02699050600676982 (DOI)000238947100006 ()16754286 (PubMedID)
Available from: 2004-05-05 Created: 2004-05-05 Last updated: 2013-10-07Bibliographically approved
3. Playing ice hockey and basketball increases serum levels of S-100B in elite players: a pilot study
Open this publication in new window or tab >>Playing ice hockey and basketball increases serum levels of S-100B in elite players: a pilot study
2003 (English)In: Clinical Journal of Sports Medicine, ISSN 1050-642X, E-ISSN 1536-3724, Vol. 13, no 5, 292-302 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate changes in serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase (NSE) in ice hockey and basketball players during games. Design: Descriptive clinical research. Setting: Competitive games of the Swedish Elite Ice Hockey League and the Swedish Elite Basketball League. Participants: Twenty-six male ice hockey players (from two teams) and 18 basketball players (from two teams). Interventions: None. Main Outcome Measures: S-100B and NSE were analyzed using two-site immunoluminometric assays. The numbers of acceleration/deceleration events were assessed from videotape recordings of the games. Head trauma-related symptoms were monitored 24 hours after the game using the Rivermead Post Concussion Symptoms Questionnaire. Results: Changes in serum concentrations of S-100B (postgame - pregame values) were statistically significant after both games (ice hockey, 0.072 +/- 0.108 [mu]g/L, P = 0.00004; basketball, 0.076 +/- 0.091 [mu]g/L, P = 0.001). In basketball, there was a significant correlation between the change in S-100B (postgame - pregame values) and jumps, which were the most frequent acceleration/deceleration (r = 0.706, P = 0.002). For NSE, no statistically significant change in serum concentration was found in either game. For one ice hockey player who experienced concussion during play, S-100B was increased more than for the other players.Conclusions: S-100B was released into the blood of the players as a consequence of game-related activities and events. Analysis of the biochemical brain damage markers (in particular S-100B) seems to have the potential to become a valuable additional tool for assessment of the degree of brain tissue damage in sport-related head trauma and probably for decision making about returning to play.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, Inc.Annotation(s), 2003
Keyword
brain injury, concussion, head injury, sport, ice hockey, basketball
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-3929 (URN)000185714700004 ()14501312 (PubMedID)
Available from: 2004-05-05 Created: 2004-05-05 Last updated: 2013-10-07Bibliographically approved
4. Playing soccer increases serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase in elite players: a pilot study
Open this publication in new window or tab >>Playing soccer increases serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase in elite players: a pilot study
2004 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301x, Vol. 18, no 9, 899-909 p.Article in journal (Refereed) Published
Abstract [en]

Primary objective : To analyse serum concentrations of two biochemical markers of brain tissue damage, S-100B and NSE (neurone-specific enolase), in male soccer players in connection to the game. Methods : Blood samples were taken in players before and after a competitive game and the numbers of headers and of trauma events during soccer play were assessed. Results : Both S-100B and NSE were significantly raised in serum samples obtained after the game in comparison with the pre-game values (S-100B: 0.118 ± 0.040 µg L -1 vs 0.066 ± 0.025 µg L -1 , p < 0.001; NSE: 10.29 ± 2.16 µg L -1 vs 8.57 ± 2.31 µg L -1 , p < 0.001). Only changes in S-100B concentrations (post-game minus pre-game values) were statistically significantly correlated to the number of headers ( r = 0.428, p = 0.02) and to the number of other trauma events ( r = 0.453, p = 0.02). Conclusion : Playing competitive elite soccer was found to cause increase in serum concentrations of S-100B and NSE. Increases in S-100B were significantly correlated to the number of headers, and heading may accordingly have contributed to these increases.

Place, publisher, year, edition, pages
Taylor & Francis Ltd, 2004
Keyword
Adult, Biological Markers/blood, Brain Concussion/blood, Craniocerebral Trauma/blood/etiology, Fatigue/etiology, Humans, Male, Nerve Growth Factors, Phosphopyruvate Hydratase/*blood, Pilot Projects, S100 Proteins/*blood, Sleep Disorders/etiology, Soccer/injuries
Identifiers
urn:nbn:se:umu:diva-3930 (URN)10.1080/02699050410001671865 (DOI)15223742 (PubMedID)
Available from: 2004-05-05 Created: 2004-05-05 Last updated: 2010-08-23Bibliographically approved

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Stålnacke, Britt-Marie

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