Currently used assessments are subjective, have poor reliability & can be gamed.
Most EDs don’t use these tools as they are inaccurate & time consuming.
mTBI patients often leave the ED with no educational information.
Associated published research
Kontos AP, Jorgensen-Wagers K, Trbovich AM, et al. Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion. JAMA Neurol. 2020;77(4):435–440.
Raab CA, Peak AS, Knoderer C. Half of Purposeful Baseline Sandbaggers Undetected by ImPACT's Embedded Invalidity Indicators. Arch Clin Neuropsychol. 2020 Apr 20;35(3):283-290.
Resch JE, Brown CN, Schmidt J, Macciocchi SN, Blueitt D, Cullum CM, Ferrara MS. The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one. BMJ Open Sport Exerc Med. 2016 Jan 19;2(1):e000012.
O’Brien, A. M., Casey, J. E., & Salmon, R. M. (2017). Short-term test–retest reliability of the ImPACT in healthy young athletes. Applied Neuropsychology: Child, 1–9. doi:10.1080/21622965.2017.1290529
Nelson LD, Temkin NR, Dikmen S, et al. Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. JAMA Neurol. 2019;76(9):1049‐1059.
Bazarian JJ,McClung J, Cheng YT, FlesherW, Schneider SM. Emergency department management of mild traumatic brain injury in the USA. Emerg Med J. 2005;22(7):473-477.
Brain Function Index (BFI) identifies profile of brain function impairment
Goes beyond the standardly used concussion assessment tools which are subjective in nature and cannot be easily performed at point of care
Scales with severity
Can be used in the ED to inform referrals for CT- patients
Brain Function Index
Using the rapidly acquired EEG data, BrainScope also provides an objective assessment of brain function impairment, including concussion, with the Brain Function Index (BFI) algorithm. The BFI includes only EEG features, especially those that measure changes in “connectivity” between brain regions, reflecting the physiological changes seen in concussion.
The BFI is expressed as a percentile of a non head-injured population, from 0 to 100, with a lower score showing higher levels of impairment. This enables clinicians to make more confident clinical diagnoses of concussion using objective physiological data.
In the FDA validation study, the Brain Function Index was demonstrated to scale with severity of functional impairment: as the BFI goes down, the level of functional impairment increases. The assessment is indicated for use on patients 18-85 years of age, within 72 hours of head injury, and GCS 13-15.
The Concussion Index (CI) assessment incorporates rapidly acquired EEG data, cognitive performance testing, and specific clinical signs/symptoms into a multimodal algorithm to objectively assess concussion, with the largest contribution from EEG features only.
The CI is expressed as an index from 0 to 100 with a lower score indicating greater severity of injury. The CI assessment can be used to longitudinally assess patients at baseline, injury, and recovery time points. Baseline assessment can be used to establish a patient-specific reference point to aid in evaluation of an injury at a later point in time. Following injury, the CI assessment can aid in clinical decision making at the time of injury, throughout recovery and when making return to play/activity decisions.
In the FDA Validation study, the CI was demonstrated to have high accuracy in identifying the likelihood of concussion within 72 hours of injury, to be a stable measure over time in non head-injured populations, and that it can be reliably interpreted as a measure of change over time. Injured patients with CIs less than or equal to threshold (70) are classified as Likely Concussed, and those with CIs greater than the threshold are classified as Not Likely Concussed. The assessment is indicated for use on patients 13-25 years of age and GCS 15.
The BrainScope® device includes a customizable battery of five cognitive performance tests, which are performed by the patient on the handheld device. These tests measure several cognitive functions including visuomotor reaction time, simple motor speed, working memory, and response control. Results can be calculated in comparison to normative data based on the non head-injured population of the same age and gender and in comparison to previous results for that patient using a reliable change index computation.
To supplement the EEG-based and cognitive performance assessments, BrainScope has digitized several standard clinical assessments commonly used by clinicians to assess head-injured patients. The digitized assessments are completed on the handheld and results for selected assessments are included in the patient PDF report and are displayed with their original intended formatting. Digitized Assessments include:
• PECARN Decision Rule • Sports Concussion Assessment Test (SCAT5) • Military Acute Concussion Evaluation (MACE 2) • Near Point Convergence (NPC) and others.