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PLoS One. 2014 Jan 8;9(1):e84977. doi: 10.1371/journal.pone.0084977. eCollection 2014.

Subject-specific increases in serum S-100B distinguish sports-related concussion from sports-related exertion.

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Department of Trauma Surgery, Klinikum der Universität München, Ludwig-Maximilians Universität, München, Germany.
Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, United States of America.
Department of Neurosurgery, Klinikum der Universität München, Ludwig-Maximilians Universität, München, Germany.
Department of Athletics and Recreation, University of Rochester, Rochester, New York, United States of America.
Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, United States of America.
Department of Trauma Surgery, Technical University of Munich, München, Germany.



The on-field diagnosis of sports-related concussion (SRC) is complicated by the lack of an accurate and objective marker of brain injury.


To compare subject-specific changes in the astroglial protein, S100B, before and after SRC among collegiate and semi-professional contact sport athletes, and compare these changes to differences in S100B before and after non-contact exertion.


Longitudinal cohort study.


From 2009-2011, we performed a prospective study of athletes from Munich, Germany, and Rochester, New York, USA. Serum S100B was measured in all SRC athletes at pre-season baseline, within 3 hours of injury, and at days 2, 3 and 7 post-SRC. Among a subset of athletes, S100B was measured after non-contact exertion but before injury. All samples were collected identically and analyzed using an automated electrochemiluminescent assay to quantify serum S100B levels.


Forty-six athletes (30 Munich, 16 Rochester) underwent baseline testing. Thirty underwent additional post-exertion S100B testing. Twenty-two athletes (16 Rochester, 6 Munich) sustained a SRC, and 17 had S100B testing within 3 hours post-injury. The mean 3-hour post-SRC S100B was significantly higher than pre-season baseline (0.099±0.008 µg/L vs. 0.058±0.006 µg/L, p = 0.0002). Mean post-exertion S100B was not significantly different than the preseason baseline. S100B levels at post-injury days 2, 3 and 7 were significantly lower than the 3-hour level, and not different than baseline. Both the absolute change and proportional increase in S100B 3-hour post-injury were accurate discriminators of SRC from non-contact exertion without SRC (AUC 0.772 and 0.904, respectively). A 3-hour post-concussion S100B >0.122 µg/L and a proportional S100B increase of >45.9% over baseline were both 96.7% specific for SRC.


Relative and absolute increases in serum S100B can accurately distinguish SRC from sports-related exertion, and may be a useful adjunct to the diagnosis of SRC.

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