From suspect to detect in minutes

Naunheim R, Konstantinovic Koscso M, Poirier R. Reduction in unnecessary CT scans for head injury in the emergency department using an FDA cleared device. American Journal of Emergency Medicine. 2019 Oct;37(10):1987-1988. doi: 10.1016/j.ajem.2019.04.037

Article Info

Emergency Department (ED) visits for mild Traumatic Head Injury (mTBI) have greatly increased due to more awareness of potential consequences of such injuries. While the vast majority (>80%) of mTBI patients who go to the ED receive a head CT scan, >90% of them are found to be negative. This practice unnecessarily exposes these patients to radiation, increases the use of ED resources, and lengthens throughput times. The integration of reliable, objective predictors of intracranial injury for making important initial assessment decisions can impact significantly on this practice.

A patient with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function, as manifested by at least one of the following:

1. Any period of loss of consciousness;

2. Any loss of memory for events immediately before or after the accident;

3. Any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused); and

4. Focal neurological deficit(s) that may or may not be transient; but where the severity of the injury does not exceed the following: loss of consciousness of approximately 30 minutes or less; after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13–15; and post traumatic amnesia (PTA) not greater than 24 hours.

This definition includes:

1. The head being struck,

2. The head striking an object, and

3. The brain undergoing an acceleration/deceleration movement (i.e., whiplash) without direct external trauma to the head.

Ref : www.acrm.org

Hanley D, Prichep LS, Badjatia N, Bazarian J, Chiacchierini R, Curley K, Garrett J, Jones E, Naunheim R, O'Neil B, O'Neill J, Wright DW, Huff JS. A Brain Electrical Activity (EEG) Based Biomarker of Functional Impairment in Traumatic Head Injury: A Multisite Validation Trial. Journal of Neurotrauma. 2018; 35(1):41-47.

Hanley D, Prichep LS, Bazarian J, Huff JS, Naunheim R, Garrett J, Jones E, Wright DW, O'Neill J, Badjatia N, Gandhi D, Curley K, Chiacchierini R, O'Neil B, Hack D.  Emergency Department Triage of Traumatic Head Injury Using Brain Electrical Activity Biomarkers: A Multisite Prospective Observational Validation Trial.  Academic Emergency Medicine. 2017; 24(5):617-627.