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Near-Infrared Spectroscopy: A Promising Prehospital Tool for Management of Traumatic Brain Injury

Published online by Cambridge University Press:  29 March 2017

Joost Peters ,
Bas Van Wageningen ,
Nico Hoogerwerf  and
Edward Tan
Joost Peters*
Affiliation:
Department of Trauma Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GAThe Netherlands Helicopter Emergency Medical Service, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GAThe Netherlands
Bas Van Wageningen
Affiliation:
Department of Trauma Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GAThe Netherlands Helicopter Emergency Medical Service, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GAThe Netherlands
Nico Hoogerwerf
Affiliation:
Helicopter Emergency Medical Service, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GAThe Netherlands Department of Anaesthesiology, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GAThe Netherlands
Edward Tan
Affiliation:
Department of Trauma Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GAThe Netherlands Helicopter Emergency Medical Service, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GAThe Netherlands
*
Correspondence: Joost Peters, MD Department of Surgery Radboud University Medical Center Geert Grooteplein Zuid 10 6525 GA Nijmegen, The Netherlands E-mail: [email protected]
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Abstract

Introduction

Early identification of traumatic brain injury (TBI) is essential. Near-infrared spectroscopy (NIRS) can be used in prehospital settings for non-invasive monitoring and the diagnosis of patients who may require surgical intervention.

Methods

The handheld NIRS Infrascanner (InfraScan Inc.; Philadelphia, Pennsylvania USA) uses eight symmetrical scan points to detect intracranial bleeding. A scanner was tested in a physician-staffed helicopter Emergency Medical Service (HEMS). The results were compared with those obtained using in-hospital computed tomography (CT) scans. Scan time, ease-of-use, and change in treatment were scored.

Results

A total of 25 patients were included. Complete scans were performed in 60% of patients. In 15 patients, the scan was abnormal, and in one patient, the scan resulted in a treatment change. Compared with the results of CT scanning, the Infrascanner obtained a sensitivity of 93.3% and a specificity of 78.6%. Most patients had severe TBI with indication for transport to a trauma center prior to scanning. In one patient, the scan resulted in a treatment change. Evaluation of patients with less severe TBI is needed to support the usefulness of the Infrascanner as a prehospital triage tool.

Conclusion

Promising results were obtained using the InfraScan NIRS device in prehospital screening for intracranial hematomas in TBI patients. High sensitivity and good specificity were found. Further research is necessary to determine the beneficial effects of enhanced prehospital screening on triage, survival, and quality of life in TBI patients.

PetersJ, Van WageningenB, HoogerwerfN, TanE. Near-Infrared Spectroscopy: A Promising Prehospital Tool for Management of Traumatic Brain Injury. Prehosp Disaster Med. 2017;32(4):414–418.

Keywords

diagnostic equipmentinfrared spectrophotometryprehospital emergency caretraumatic brain injury
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 4 , August 2017 , pp. 414 - 418
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest/funding: The Infrascanner used was provided by InfraScan Inc. (Philadelphia, Pennsylvania USA) free of charge. No funding or research support was received by the HEMS, the research team, or the authors of this article. A portion of this article was previously published in Dutch.18 Permission to publish these data was granted by the publisher. None of the authors had competing interests in relation to this study.

References

1. Dismuke, CE, Walker, RJ, Egede, LE. Utilization and cost of health services in individuals with traumatic brain injury. Glob J Health Sci. 2015;7(6):156-169.CrossRefGoogle ScholarPubMed
2. Pfeifer, R, Tarkin, IS, Rocos, B, Pape, HC. Patterns of mortality and causes of death in polytrauma patients--has anything changed? Injury. 2009;40(9):907-911.CrossRefGoogle ScholarPubMed
3. Brazinova, A, Mauritz, W, Leitgeb, J, et al. Outcomes of patients with severe traumatic brain injury who have Glasgow Coma Scale scores of 3 or 4 and are over 65 years old. J Neurotrauma. 2010;27(9):1549-1555.CrossRefGoogle ScholarPubMed
4. Hoogmartens, O, Heselmans, A, Van de Velde, S, et al. Evidence-based prehospital management of severe traumatic brain injury: a comparative analysis of current clinical practice guidelines. Prehosp Emerg Care. 2014;18(2):265-273.CrossRefGoogle ScholarPubMed
5. Boer, C, Franschman, G, Loer, SA. Prehospital management of severe traumatic brain injury: concepts and ongoing controversies. Curr Opin Anaesthesiol. 2012;25(5):556-562.CrossRefGoogle ScholarPubMed
6. Ghosh, A, Elwell, C, Smith, M. Review article: cerebral near-infrared spectroscopy in adults: a work in progress. Anesth Analg. 2012;115(6):1373-1383.Google Scholar
7. Davies, DJ, Su, Z, Clancy, MT, et al. Near-infrared spectroscopy in the monitoring of adult traumatic brain injury: a review. J Neurotr. 2015;32(13):933-941.CrossRefGoogle ScholarPubMed
8. Ding, K, Wang, H, Wu, Y, et al. Rapamycin protects against apoptotic neuronal death and improves neurologic function after traumatic brain injury in mice via modulation of the mTOR-p53-Bax axis. J Surg Res. 2015;194(1):239-247.Google Scholar
9. Katzenberger, RJ, Chtarbanova, S, Rimkus, SA, et al. Death following traumatic brain injury in Drosophila is associated with intestinal barrier dysfunction. Elife. 2015;4.CrossRefGoogle ScholarPubMed
10. Robertson, CS, Zager, EL, Narayan, RK, et al. Clinical evaluation of a portable near-infrared device for detection of traumatic intracranial hematomas. J Neurotr. 2010;27(9):1597-1604.CrossRefGoogle ScholarPubMed
11. Leon-Carrion, J, Dominguez-Roldan, JM, Leon-Dominguez, U, Murillo-Cabezas, F. The Infrascanner, a handheld device for screening in situ for the presence of brain hematomas. Brain Inj. 2010;24(10):1193-1201.Google Scholar
12. Salonia, R, Bell, MJ, Kochanek, PM, Berger, RP. The utility of near infrared spectroscopy in detecting intracranial hemorrhage in children. J Neurotr. 2012;29(6):1047-1053.CrossRefGoogle ScholarPubMed
13. Bressan, S, Daverio, M, Martinolli, F, et al. The use of handheld near-infrared device (Infrascanner) for detecting intracranial hemorrhages in children with minor head injury. ChNS. 2014;30(3):477-484.Google ScholarPubMed
14. Braun, T, Kunz, U, Schulz, C, Lieber, A, Willy, C. [Near-infrared spectroscopy for the detection of traumatic intracranial hemorrhage: feasibility study in a German army field hospital in Afghanistan]. Unfallchirurg. 2014.Google Scholar
15. Bajoghli, M, Bajoghli, F, Tayari, N, Rouzbahani, R. Children, CT scan, and radiation. Int J Prev Med. 2010;1(4):220-222.Google ScholarPubMed
16. Hoshiko, S, Smith, D, Fan, C, Jones, CR, McNeel, SV, Cohen, RA. Trends in CT scan rates in children and pregnant women: teaching, private, public, and nonprofit facilities. Pediatr Radiol. 2014;44(5):522-528.Google Scholar
17. Blume, HK. Children with minor blunt head trauma, a Glasgow Coma Scale score of 14 or 15, and a normal CT scan are at very low risk of traumatic findings on subsequent neuroimaging or of requiring neurosurgical intervention. Evid Based Med. 2012;17(6):e11.CrossRefGoogle ScholarPubMed
18. Tan, EC, Peters, JH, Hoogerwerf, N. Prehospitaal gebruik van een mobiele near-infrared spectroscopie scanner voor diagnostiek bij patiënten met een traumatisch schedelhersenletsel. Netherlands Mil Med Rev. 2015;68(2):22-24.Google Scholar