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Evalua&on de la performance et de l’intérêt de la PS100B chez les pa&ents présentant un Trauma&sme Crânien Léger.
Faible intérêt chez les pa&ents > 75 ans.
Dr A.Bourrier CHU de Nice
INTRODUCTION • TCL
ü Fréquence : 200 000 / an ü Gravité TCL: < 10% lésions TDM ü Enjeu: financier et santé publique
• PS100β ü Sensibilité + VPN => RAD sans TDM ü Etudes: pédiatrie et médiane d’âge 60 ans ü Pb pa&ents âgés: chutes fréquentes et seuil de PS100β / altéra&on fonc&ons supérieures
HYPOTHESES ET OBJECTIFS
• PS100β moins performante > 75 ans ⇒ Evalua&on de la fiabilité de la PS100β vs TDM
⇒ Intérêt du dosage de la PS100β / âge
MATERIELS ET METHODE • Etude observa&onnelle prospec&ve • Non interven&onnelle • Résultat à postériori
• Analyse sta&s&que: Mann et Whitney, ROC
Inclusion Non inclusion ≥ 18 ans GSG 13-‐15
Isolé < 3 heures
GSG < 13 Embarrure
Signe de focalisa&on Polytrauma&sme
RESULTATS / Total
• 344 pa&ents inclus
• Age médian 74,5 ans
• Prévalence TDM aN 23,8%
• Valeur seuil PS100β < 0,10 vs TDM: VPN 100% et sensibilité 97,7%
9%
17%
26% 5%
5%
38%
Type de lésions TDM
HSA
Fractures
HSD
HED
Petechies
Lésions mul&ples
base du crâne
RESULTATS / Total et Age
• Caractéris&ques des pa&ents
• TDM évités: 18,6% < 75 ans vs 7% ≥ 75 ans
Total (n = 344)
Age < 75 ans (n = 172)
Age > 75 ans (n = 172)
p
Age (médiane [IQR]) 74.5 [49-‐85] 48 [30-‐62] 85 [82-‐91] Sex Ratio H/F 1.02 2.15 0.5 <0.001
Score de Glasgow 15 [15-‐15] 15 [15-‐15] 15 [14-‐15] 0.07 Retour à domicile 231 (67%) 114 (66.4%) 116 (67.6%) 0.96
Altération des fonctions cognitives 69 (20,2%) 0 69 (40.1%) <0.001 TDM anormal 90 (26.1%) 51 (29.9%) 39 (22.7%) 0.27
Lésion Cérébrale 59 (17%) 31 (18%) 28 (16.3%) 0.90 Valeur du p correspond à la comparaison entre patients âgés et jeunes
RESULTATS / TDM aN
• ROC: ü < 75 ans : significa&f o AUC 0,75 p<0,0001
ü ≥ 75 ans : NON significa&f o AUC 0,59 p=0,06
RESULTATS / Lésion cérébrale
• ROC: ü < 75 ans : significa&f o AUC 0,73 p<0,0001
ü ≥ 75 ans : NON significa&f :
o AUC 0,57 p=0,29
DISCUSSION
• Performance PS100β / détec&on pa&ents « non » à risque de lésion cérébrale
• Seuil 0,10 ng/mL = TDM N => pas de nécessité de TDM
• Mais stratégie moins « rentable » ≥ 75 ans
• Par&cularités de notre étude: ü Médiane d’âge : 74,5 ans versus 39 et 57 ans ü Prévalence TDM aN 23,8% versus < 10%
DISCUSSION
• => TDM « évités » : Données de la limérature: 12-‐30 %
versus 18,6% < 75 ans vs 7% ≥ 75 ans
ü Prévalence ü Organisa&onnel ü « Recrutement »
CONCLUSION
• Performance de la PS100β / TCL
• VPN et sensibilité excellentes si < 0,10 ng/mL
• Faible intérêt ≥ 75 ans / rentabilité et radia&ons ionisantes
• Intérêt pronos&c?
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