Authors: Robert M. Gramer; Robert Gramer, BS; Anthony Fuller; Lexie Yang, PhD; Donna Niedzwiecki, PhD; Carmelo Graffagnino, MD; Beth Perry, BS; Michael Haglund, MD, PhD (Toronto, Canada)
The World Health Organization estimates that more than 10 million people sustain traumatic brain injury (TBI) resulting in death or significant irreversible deficits annually, the majority occurring in low and middle-income countries (LMICs). When subdural (SDH) and/or epidural (EDH) hematomas occur, the limited availability of computer tomography (CT) in these TBI-laden areas frequently impedes life-saving neurosurgical decompression. As neurosurgical infrastructure in LMICs continues to expand, a reliable, accessible, cost-effective solution to detect and localize such bleeds is imperative.
500 consecutive patients presenting to Duke University Hospital Emergency Department with confirmed or suspected head trauma who received a head CT scan were included in this study. Within thirty-minutes of the initial head CT scan, an examiner, blinded to the result, scanned each patient’s cranium with a near-infrared device (NIRD), interrogating frontal, temporal, parietal, and occipital quadrants bilaterally. A difference in optical density >|.20| was considered a positive result, indicative of an intracranial bleed. For all NIRD-positive patients who underwent subsequent CT scans, serial NIRD measurements were collected.
104 patients had an intracranial bleed(s). For all patients with CT-proven bleeds, irrespective of size, initial NIRD scans localized the bleed to the appropriate quadrant with a sensitivity of 86% and specificity of 96% compared to CT scan. For extra-axial bleeds >3.5ml, sensitivity and specificity were 94% and 96%, respectively. For longitudinal serial rescans with the NIRD, sensitivity was 89% (<4 days from injury: sensitivity=99%) and specificity was 96%.
These data demonstrate that a NIRD is both highly sensitive and specific in diagnosing inctracranial bleeds. For all patients who required craniectomy or craniotomy, the device demonstrated 100% sensitivity. With these results, we intend to initiate a feasibility trial in Uganda using a NIRD to diagnose SDH/EDH and inform neurosurgical care where our group, DGNN, is working to build neurosurgical capacity.