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Master Thesis

Perspectives d'amélioration de la prise en charge des céphalées intenses aux urgences liées à l'utilisation d'un bio-marqueur : la protéine S100β

Abstract : Introduction: The strategy for diagnosing intracerebral haemorrhage revealed by headache is now mainly based on the cerebral scanner and lumbar puncture pair. However, these procedures are not without adverse effects and significantly prolong the time spent in the emergency room. The S100β protein is a bio-marker that has shown promise in the diagnosis of elimination of intracerebral hemorrhage in mild traumatic brain injury. The objective of our study is to evaluate the interest of dosing the S100β protein in the management strategy of intense headaches (defined by an numerical scale greater than or equal to 6) by estimating the negative predictive value of the protein S100β to exclude subarachnoid or intracranial haemorrhage. Method: A prospective, nonrandomized, multicentric study of the performance of a diagnostic test, was carried out in the HIA Sainte Anne and Laveran; and Sainte Musse Hospital Center. Every patient admitted to the emergency department for an intense, non-traumatic headache of less than 3 hours was included. These patients have all benefited from an assay of the S100β protein and the realization of a brain scanner, considered as gold standard. The data collected included biographical data, medical history, the clinical state and the results of any complementary examination (biomarker, brain scan and lumbar puncture if it was performed). An interim analysis was performed on 31 patients. Results: The population analysed included 21 women and 10 men for an average age of 48 years (range [21-80 years]). A total of 4 patients had subarachnoid haemorrhage for a frequency of 12.9% in our study. After comparing the data collected between the sick group and the SHA-free patients, a statistically significant difference was found in age, pain assessment, and SBP. The negative predictive value of the S100β protein assay with a discriminatory threshold of 0.10μg/l or less in the diagnosis of elimination of intracranial hemorrhage was 89% [95% confidence interval CI = 0.78 to 1]. Conclusion: The 31-patient interim analysis currently suggests that assaying the S100β protein with a 0.10 μg/L discriminatory threshold is not of interest in the management strategy of severe headache.
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https://dumas.ccsd.cnrs.fr/dumas-02383885
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Submitted on : Thursday, November 28, 2019 - 9:41:39 AM
Last modification on : Wednesday, September 2, 2020 - 4:41:10 PM
Long-term archiving on: : Saturday, February 29, 2020 - 1:55:56 PM

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Pauline Muller. Perspectives d'amélioration de la prise en charge des céphalées intenses aux urgences liées à l'utilisation d'un bio-marqueur : la protéine S100β. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02383885⟩

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