In a new clinical trial, researchers found that imaging is not the only tool that can be used to diagnose head injury with accuracy. A hand-held electroencephalogram (EEG) device proved a viable method of diagnosing brain bleeding.
According to the Centers for Disease Control and Prevention (CDC), more than 2.5 million Americans show up to the emergency room with suspected head injuries and undergo a CT scan. Over 90 percent of these images will show no results of brain damage, which in turn leads to exposing patients to needless radiation and expensive medical costs.
The study, published in Academic Emergency Medicine, noted that researchers are not using this technology to replace CT scans for patients with mild head injury, but were instead hoping to provide further information to facilitate routine clinical decision making.
“If someone with a mild head injury was evaluated on the sports field or battlefield, then this test could assist in the decision of whether or not he or she needs rapid transport to the hospital,” said Daniel Hanley Jr., MD, lead investigator, in a statement. “Alternatively, if there is an accident with many people injured, medical personnel could use the device to triage which patients would need to have CT scans and who should go first. Those showing a ‘positive’ for brain injury would go first.”
Researchers only assessed adults with this device and did not test how well the EEG could predict traumatic brain injuries in children or teens.
According to Hanley, the study was designed to test the accuracy and effectiveness of AHEAD 300, a device developed to assess the likelihood that a patient has more than 1 milliliter of bleeding in the brain and needs immediate evaluation by medical personnel.
The study included 720 adults from 11 emergency departments nationwide, who were admitted in 2015 with a closed head injury. When a patient entered the ER, the physician performed a standard clinical assessment for head injuries, followed by a technician administering the Standardized Assessment of Concussion and the Concussion Symptom Inventory to characterize the patient’s symptoms. They then used the AHEAD 300 device to measure EEG data.
The EEG device was programmed to read about 30 specific features of brain electrical activity, which was analyzed by an algorithm, and compared how the patient’s brain pattern differed from brain activity that was considered normal. To test if the device was accurate, CT scans were also performed. If any blood within the intracranial cavity was present, it was considered to be a positive finding, indicating brain bleeding. Researchers followed up with patients through phone calls and/or from medical records after 30 days to validate the accuracy of each patient’s injury status.
Some 564 of the 720 adults turned out to have no traumatic brain injuries, while 156 patients did, which was determined by CT scan assessments. With the AHEAD 300 device, 291 patients scored as likely not having a brain injury, while 144 were assessed to likely have an injury. Of those confirmed with brain bleeding via CT scan, 12 participants had some intracranial bleeding and five participants had more than a millileter of blood in the brain. Researchers also sorted patients by yes, no and maybe to see if this boosted the accuracy of the device.
"The researchers say these predictive capabilities improve on the clinical criteria currently used to assess whether to do a CT scan—known as the New Orleans Criteria and the Canadian Head CT rules—and predicted the absence of brain bleeding more than 70 percent of the time in those people with no more than one symptom of brain injury, such as disorientation, headache or amnesia," according to the report.