Reduction of low clinical value head CTs is a recognized quality initiative among clinical associations, hospitals, and the government. However, in the Emergency Department (ED), over 80% of mild head injured patients still receive a head CT although >90% are found to be negative.1 Nearly 30% of emergency physicians self-reported that they continue to order head CTs for mild head injured patients because of concern for serious diagnosis and/or pressure to meet patient/family expectations.
BrainScope may bridge the disconnect between initiatives such as Choosing Wisely and Emergency Clinicians continuing to order low-value CTs in minor head trauma. BrainScope’s value proposition fulfills the promise of Emergency Medicine and helps improve the care of patients with minor head injury in the ED by aiding in reducing low-value head CT utilization. A clinical study demonstrated the potential to reduce low value head CTs by 30%. When integrated into clinical practice, real-world experience has shown a reduction of 40-60%.2
When BrainScope conducted its multisite, independent FDA validation study, comparisons were made to results of CT Scan of the head (standard practice) to determine the sensitivity of this non-invasive device in risk stratifying patients for structural brain injuries.3 The study demonstrated 99% sensitivity to ≥ 1mL of blood and 98% negative predictive value. In a retrospective analysis of the validation study data, the authors report that integrating BrainScope at triage would have a 33% reduction in the number of CT scans in this ED patient population.4
Following FDA clearance, BrainScope has been used in clinical practice, starting with convenience sampling of patients in single-centered EDs alongside usual practice in patients aged 18-85 with a GCS of 13-15 within 72 hours of injury. In one such study, all patients received a CT Scan, and were also evaluated with BrainScope. This study predicted a 30.8% reduction in low-value head CT scans had BrainScope been used prospectively in triage for all eligible patients. Further, this reduction in CT scans would have been achieved without any false negatives.5 In this controlled environment, BrainScope can reduce ED CT scans in minor head injury patients by at least 26-31%.
To make this reduction more concrete in a 40,000 visit/year ED, there will be approximately 672 patients likely to receive a head CT. If BrainScope is integrated into clinical practice, approximately 270 patients will avoid a low-value head CT and its associated radiation.
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2. Clay, M.S., (2021) Clinical Utility of an EEG Based Biomarker for the Triage of Head Injured Patients in the ED: INOVA Pilot Study BrainScope White Paper, August 2021
3. Hanley, D., Prichep, L. S., Bazarian, J., Huff, J. S., Naunheim, R., Garrett, J., ... & Hack, D. C. (2017). Emergency department triage of traumatic head injury using a brain electrical activity biomarker: a multisite prospective observational validation trial. Academic emergency medicine, 24(5), 617-627.
4. Huff, J. S., Naunheim, R., Dastidar, S. G., Bazarian, J., & Michelson, E. A. (2017). Referrals for CT scans in mild TBI patients can be aided by the use of a brain electrical activity biomarker. The American Journal of Emergency Medicine, 35(11), 1777-1779.
5. Naunheim, R., Koscso, M. K., & Poirier, R. (2019). Reduction in unnecessary CT scans for head-injury in the emergency department using an FDA cleared device. The American Journal of Emergency Medicine, 37(10), 1987-1988.
