Determining the predictive power of Neuron Specific Enolase (NSE) for traumatic brain injury (TBI) in patients with head trauma

Background:The presence of a predictor for traumatic brain injury (TBI) in patients with head trauma could play a crucial role to identify patients at higher risk of brain injury. The aim of this study is to explore neuron specific enolase (NSE) association with TBI in patients with head trauma. Methods: This is an observational study conducted on the patients with isolated blunt head trauma. A total of 168 subjects were enrolled in the study, of whom 84 participants had isolated blunt head trauma and 84 individuals with no head trauma were allocated to the control group. Serum concentration of NSE in all included subjects was measured within the first 6 hours. All the patients underwent brain CT-scan. Data were collected in the checklist. Statistical analysis was carried out using SPSS v.19. Independent t-test, one way ANOVA and Chi Square tests were used for analytical analysis. The ROC curve was plotted and cut-off values of serum neuron-specific enolase were determined in terms of their sensitivity and specificity to predict intracranial injuries. Results: The mean serum NSE concentration for patients with head trauma and controls was 23.14±22.63 ng/ml (18.77-28.39, 95% CI) and 7.00±4.42 ng/ml (3.67-10.33, 95% CI), respectively so that the difference was significant (p=0.049). Furthermore, serum NSE level was significantly higher in cases with severe trauma compared with the group with mild trauma (p=0.023). According to our findings, NSE ≤ 15.5 ng/ml can rule out the likelihood of brain injury associated with head trauma with a sensitivity of 100% and a specificity of 88%. Conclusion: NSE can be helpful to predict severe brain injury in patients with head trauma where CT-scan or other diagnostic tools are not available. According to our results, where serum NSE level is ≤ 15.5 ng/ml, clinicians can rule out the possibility of severe head injury after head trauma.

Keywords:

Neuron specific enolase (NSE) , Head trauma , Brain injury , Prognosis