Patients with anti-platelet agents (such as aspirin or clopidogrel) were included. Exclusion criteria were age less than 18 years, non-Swedish citizens (difficult to follow up), neurological

deficits, additional risk factors from the SNC guidelines (therapeutic anticoagulation or haemophilia, clinical signs of depressed skull fracture or skull base fracture, posttraumatic seizures, shunt-treated hydrocephalus and multiple injuries) and patients where serum sampling for S100B was done more than 3 hours post-injury. Our goal was to include 500 patients in the study, based upon consensus in the study group when considering the aim of the study. A sample size calculation was not performed. The study was conducted in accordance to the Helsinki Declaration Inhibitors,research,lifescience,medical and approved by the Inhibitors,research,lifescience,medical Lund regional ethical committee, Lund, Sweden (reference number 19/2007). Since the study

did not involve any change in patient management and based upon clinical practice, informed consent was not necessary and the ethics committee concurred with this decision. Blood sampling and biochemical analysis A 5ml blood sample was drawn from each patient’s cubital vein in the ED. Samples were analysed with the fully automated Elecsys® S100 (Roche AB) at the Clinical Chemistry Department of Halmstad Regional hospital, Sweden. Roche AB report a range between 0.005μg/L and 39μg/L and a within-series coefficient of Inhibitors,research,lifescience,medical variance of <2.1%. Based on the available evidence at this time, we chose a cut-off level for normal levels of less than 0.10μg/L and a window Inhibitors,research,lifescience,medical of sampling of 3 hours from the time of the accident [19,23]. Lab results were available to treating physicians within 1 hour after sampling. CT examinations CT scans were performed with a GE VCT

Ligthspeed 64 multislice detector with a 0,625/0,625mm, 0,5 seconds rotation time and pitch of 0,531:1. 10mm thick slices were used as part of the standard CT protocol Inhibitors,research,lifescience,medical for these patients. CT scans are always analysed by a board certified radiologist and confirmed by a consultant radiologist. Since S100B was used clinically, radiologists were not blinded to S100B results. A CT scan was considered positive if any signs of cranial (skull fracture) or intracranial pathology (hematoma, air or contusion) were present. Standardized assessment of patients Supervised interns and surgical residents from the ED of the Halmstad Regional Hospital assessed and patients. These physicians underwent several educational sessions on evaluating patients with MHI using the new guidelines. Physicians were instructed to follow the new guidelines for all non-severe head injury patients even click here though deferral from these due to clinical judgement was allowed. Data registration and follow-up Details of how patients were managed, including patient characteristics, type of injury, patient history, medications, clinical examination results, CT results, admission type and duration were documented in an Excel spreadsheet.