Citation

Hanley D, Chabot R, Mould WA, Morgan T, Naunheim R, Sheth KN, Chiang W, Prichep LS. J. Neurotrauma 2013; 30(24): 2051-2056.

Affiliation

Johns Hopkins University School of Medicine, Division of Brain Injury Outcomes, Baltimore, Maryland, United States ; dhanley@jhmi.edu.

Copyright

(Copyright © 2013, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2013.3062

PMID

24040943

Abstract

This study investigates the potential clinical utility in the emergency department (ED) of an index of brain electrical activity to identify intracranial hematomas. The relationship between this index and depth, size, and type of hematoma was explored. Ten minutes of brain electrical activity was recorded from a limited montage in 38 adult patients with traumatic hematomas (CT scan positive) and 38 mild head injured controls (CT negative) in the ED. The volume of blood and distance from recording electrodes were measured by blinded independent experts. Brain electrical activity data was submitted to a classification algorithm independently developed TBI-Index to identify the probability of a CT+ traumatic event. There was no significant relationship between the TBI-index and type of hematoma, or distance of the bleed from recording sites. A significant correlation was found between TBI-Index and blood volume. Sensitivity to hematomas was 100%, positive predictive value (PPV) was 74.5%, and positive likelihood ratio (PLR) was 2.92. The TBI-index, derived from brain electrical activity, demonstrates high accuracy for identification of traumatic hematomas. Further, this was not influenced by distance of the bleed from the recording electrodes, blood volume, or type of hematoma. Distance and volume limitations noted with other methods, (such as that based on near-infrared spectroscopy, NIS), were not found, thus suggesting the TBI-Index to be a potentially important adjunct to acute assessment of head injury. Due to the life threatening risk of undetected hematomas (false negatives), specificity was permitted to be lower, 66%, in exchange for extremely high sensitivity.

Language: en