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      Diagnostic properties of a portable near-infrared spectroscopy to detect intracranial hematoma in traumatic brain injury patients

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          Abstract

          Traumatic brain injury (TBI) is a major public health issue worldwide. A portable near-infrared spectroscopy (NIRS) is a non-invasive device to detect intracranial hematoma. The advantages of the NIRS include real time results and non-radiation exposure. However, sensitivity and specificity of the NIRS for intracranial hematoma are varied. This study aimed to evaluate the diagnostic properties of the NIRS in TBI patients to detect intracranial hematoma. This study was a diagnostic and prospective study conducted at the Emergency Department. The inclusion criteria were adult patients (age of 18 years or over) with moderate to high risk of all degrees of traumatic brain injury within 24 h after the injury. The primary endpoint of the study was a description of diagnostic properties of the NIRS compared with the CT brain. There were 47 patients enrolled in the study. Most of patients had Glasgow Coma Scale of 15 (44 patients; 93.62 %). Of those, 11 patients (23.40 %) had intracranial hematoma: subdural hematoma (n = 9), epidural hematoma (n = 1), intracerebral hematoma (n = 1), and subarachnoid hemorrhage (n = 3). One patient had subdural hematoma, epidural hematoma, intracerebral hematoma and subarachnoid hemorrhage. There were 31 patients had abnormal findings by the NIRS but only 11 patients had bleeding detected by the CT brain. There were 16 patients had negative results on both the NIRS and the CT brain. The sensitivity and specificity of the NIRS compared with the CT brain was 100 % and 44.4 %, respectively. The area under the ROC curve of the NIRS was 0.722. The median time to complete the NIRS examination was 3 min. In conclusion, the NIRS has high sensitivity and negative predictive value for intracranial hematoma detection in mild TBI patients with extra-axial hematomas.

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          Clinical evaluation of a portable near-infrared device for detection of traumatic intracranial hematomas.

          The purpose of this multicenter observational clinical study was to evaluate the performance of a near-infrared (NIR)-based, non-invasive, portable device to screen for traumatic intracranial hematomas. Five trauma centers collected data using the portable NIR device at the time a computed tomography (CT) scan was performed to evaluate a suspected traumatic brain injury (TBI). The CT scans were read by an independent neuroradiologist who was blinded to the NIR measurements. Of 431 patients enrolled, 365 patients were included in the per-protocol population analyzed. Of the 365 patients, 96 were determined by CT scan to have intracranial hemorrhages of various sizes, depths, and anatomical locations. The NIR device demonstrated sensitivity of 88% (95% confidence interval [CI] 74.9,95.0%), and specificity of 90.7% (95% CI 86.4,93.7%), in detecting the 50 intracranial hematomas that were large enough to be clinically important (larger than 3.5 mL in volume), and that were less than 2.5 cm from the surface of the brain. For all 96 cases with intracranial hemorrhage, regardless of size and type of hemorrhage, the sensitivity was 68.7% (CI 58.3,77.6%), and specificity was 90.7% (CI 86.4,93.7%). These results confirm the results of previous studies that indicate that a NIR-based portable device can reliably screen for intracranial hematomas that are superficial and of a size likely to be of clinical importance. The NIR device cannot replace CT scanning in the diagnosis of TBI, but the device might be useful to supplement clinical information used to triage TBI patients, and in situations in which CT scanning is not readily available.
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            Global road safety crisis remedy sought: 1.2 million killed, 50 million injured annually.

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              The Infrascanner, a handheld device for screening in situ for the presence of brain haematomas.

              Early identification and treatment of intracranial haematomas in patients sustaining traumatic brain injury is fundamental to successful treatment. This pilot study evaluates the Infrascanner as a handheld medical screening tool for detection, in situ, of brain haematomas in patients with head injury. This study included 35 TBI patients aged 17-76 (M = 47.6), admitted to the neurosurgical intensive care unit and observation unit of a University Hospital in a Level 1 trauma centre. The Infrascanner NIRS device uses near infrared light measurements to calculate optical density in brain regions. Results show Infrascanner sensitivity at 89.5% and specificity at 81.2%. PPV was 85% and NPV 86.7%. The device detected 90% of extra-axial, 88.9% of intra-axial and 93.3% of non-surgical haematomas (less than 25 mL). PPV for this classification was 82.3%; 87.5% sensitivity was found when the Infrascanner exam was performed within 12 hours post-trauma, whereas after 12 hours post-trauma, exams had 90.1% sensitivity. This study demonstrates that the Infrascanner is useful in initial examinations and screenings of patients with head injury as an adjunct to a CT scan or when it is not available and may allow earlier treatment and reduce secondary injury caused by present and delayed haematomas.
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                Author and article information

                Contributors
                Journal
                Eur J Radiol Open
                Eur J Radiol Open
                European Journal of Radiology Open
                Elsevier
                2352-0477
                29 July 2020
                2020
                29 July 2020
                : 7
                : 100246
                Affiliations
                [a ]Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
                [b ]Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand
                Author notes
                [* ]Corresponding author. kittisak@ 123456kku.ac.th
                Article
                S2352-0477(20)30035-6 100246
                10.1016/j.ejro.2020.100246
                7394853
                800021a9-c1a8-4bc3-8094-516440ad347d
                © 2020 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 6 May 2020
                : 9 July 2020
                : 15 July 2020
                Categories
                Article

                sensitivity,specificity,predictive value,likelihood ratio

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