Investigation of changes in brain natriuretic peptide serum levels and its diagnostic value in patients with mild and moderate head trauma, in patients referred to emergency department of Alzahra Hospital, Isfahan, 2013-2014


Department of Emergency Medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Head trauma is one of the most common reasons for emergency department (ED) care. Over the past decade, initial management strategies in mild and moderate head trauma have become focused on selective computed tomography (CT) use based upon presence or absence of specific aspects of patient history and/or clinical examination which has received more attention following reports of increased cancer risk from CT scans. Recently changes in serum brain natriuretic peptide (BNP) levels following head trauma have been studied. We investigated the changes in serum levels of BNP in patients with mild and moderate head trauma, in whom the first brain CT scanning was normal.
Materials and Methods: This study is a cross-sectional, descriptive research. It was performed in patients with mild and moderate head trauma. Forty-one patients with isolated mild and moderate traumatic brain injury (Glasgow Coma Scale = 9–15) were included. First brain CT scans were obtained during 2 h after ED arrival and the second one after 24 h. Plasma BNP levels were determined using a specific immunoassay system.
Results: Twenty-three patients were in Group A (with normal first and second brain CT) and 18 patients in Group B (with normal first and abnormal second brain CT). With P = 0.001, serum BNP level = 9.04 was determined for differentiating two groups.
Conclusion: We concluded that serum BNP level is higher in patients with mild and moderate head trauma with delayed pathologic changes in second brain CT relative to patients with mild and moderate head trauma and with normal delayed brain CT.


Undén J, Ingebrigtsen T, Romner B; Scandinavian Neurotrauma Committee (SNC). Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: An evidence and consensus-based update. BMC Med 2013; 11:50.  Back to cited text no. 1
Heegaard WG, Biros MH. Rosen's Emergency Medicine: Concepts and General Practice. Head Injury: Elsevier Saunders; Philadelphia: 2014. p. 339-53.  Back to cited text no. 2
Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000; 343:100-5.  Back to cited text no. 3
Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009; 169:2078-86.  Back to cited text no. 4
Tauber M, Koller H, Moroder P, Hitzl W, Resch H. Secondary intracranial hemorrhage after mild head injury in patients with low-dose acetylsalicylate acid prophylaxis. J Trauma 2009; 67:521-5.  Back to cited text no. 5
Livingston DH, Lavery RF, Passannante MR, Skurnick JH, Baker S, Fabian TC, et al. Emergency department discharge of patients with a negative cranial computed tomography scan after minimal head injury. Ann Surg 2000; 232:126-32.  Back to cited text no. 6
Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature 1988; 332:78-81.  Back to cited text no. 7
Sudoh T, Minamino N, Kangawa K, Matsuo H. Brain natriuretic peptide-32: N-terminal six amino acid extended form of brain natriuretic peptide identified in porcine brain. Biochem Biophys Res Commun 1988; 155:726-32.  Back to cited text no. 8
Itoh H, Nakao K, Yamada T, Shirakami G, Kangawa K, Minamino N, et al. Antidipsogenic action of a novel peptide, 'brain natriuretic peptide', in rats. Eur J Pharmacol 1988; 150:193-6.  Back to cited text no. 9
Yamada T, Nakao K, Itoh H, Shirakami G, Kangawa K, Minamino N, et al. Intracerebroventricular injection of brain natriuretic peptide inhibits vasopressin secretion in conscious rats. Neurosci Lett 1988; 95:223-8.  Back to cited text no. 10
Mukoyama M, Nakao K, Hosoda K, Suga S, Saito Y, Ogawa Y, et al. Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest 1991; 87:1402-12.  Back to cited text no. 11
Aburaya M, Minamino N, Kangawa K, Tanaka K, Matsuo H. Distribution and molecular forms of brain natriuretic peptide in porcine heart and blood. Biochem Biophys Res Commun 1989; 165:872-9.  Back to cited text no. 12
Pesola GR. The use of B-type natriuretic peptide (BNP) to distinguish heart failure from lung disease in patients presenting with dyspnea to the emergency department. Acad Emerg Med 2003; 10:275-7.  Back to cited text no. 13
De Lemos JA, Morrow DA. Brain natriuretic peptide measurement in acute coronary syndromes: Ready for clinical application? Circulation 2002; 106:2868-70.  Back to cited text no. 14
Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998; 339:321-8.  Back to cited text no. 15
Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008; 7:728-41.  Back to cited text no. 16
Sviri GE, Soustiel JF, Zaaroor M. Alteration in brain natriuretic peptide (BNP) plasma concentration following severe traumatic brain injury. Acta Neurochir (Wien) 2006; 148:529-33.  Back to cited text no. 17
Powner DJ, Hergenroeder GW, Awili M, Atik MA, Robertson C. Hyponatremia and comparison of NT-pro-BNP concentrations in blood samples from jugular bulb and arterial sites after traumatic brain injury in adults: A pilot study. Neurocrit Care 2007; 7:119-23.  Back to cited text no. 18
Wu X, Sha H, Sun Y, Gao L, Liu H, Yuan Q, et al. N-terminal pro-B-type natriuretic peptide in patients with isolated traumatic brain injury: A prospective cohort study. J Trauma 2011; 71:820-5.  Back to cited text no. 19
Chang, Todd P, Nager, Alan L. Pediatric traumatic brain injury: The utility of beta-natriuretic peptid. J Trauma 2010; 68(6): 1401-1405.  Back to cited text no. 20
Demir A, Kavalci C, Yilmaz MS, Yilmaz F, Durdu T, Ceyhan MA, et al. The value of Serum BNP for diagnosis of intracranial injury in minor head trauma. World J Emerg Surg 2014; 9:16.  Back to cited text no. 21
Sviri GE, Shik V, Raz B, Soustiel JF. Role of brain natriuretic peptide in cerebral vasospasm. Acta Neurochir (Wien) 2003; 145:851-60.  Back to cited text no. 22
Berendes E, Walter M, Cullen P, Prien T, Van Aken H, Horsthemke J, et al. Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage. Lancet 1997; 349:245-9.  Back to cited text no. 23
Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: A public health perspective. J Head Trauma Rehabil 1999; 14:602-15.  Back to cited text no. 24
Dimopoulou I, Tsagarakis S, Korfias S, Zervakis D, Douka E, Thalassinos N, et al. Relationship of thyroid function to post-traumatic S-100b serum levels in survivors of severe head injury: Preliminary results. Intensive Care Med 2004; 30:298-301.  Back to cited text no. 25
Minamikawa J, Kikuchi H, Ishikawa M, Yamamura K, Kanashiro M. The effects of atrial natriuretic peptide on brain edema, intracranial pressure and cerebral energy metabolism in rat congenital hydrocephalus. Acta Neurochir Suppl (Wien) 1994; 60:104-6.  Back to cited text no. 26
Rosenberg GA, Estrada EY. Atrial natriuretic peptide blocks hemorrhagic brain edema after 4-hour delay in rats. Stroke 1995; 26:874-7.  Back to cited text no. 27
Cevik Y, Durukan P, Serhat E F, Yıldız M, İlhan F, Serhatlıoğlu S. Diagnostic value of bedside brain natriuretic peptide measurement in patients with head trauma. J Acad Emerg Med 2009; 9:21-5.  Back to cited text no. 28