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Triage of Mild Head-Injured Intoxicated Patients Could Be Aided by Use of an Electroencephalogram-Based Biomarker

Michelson, Edward; Huff, J. Stephen; Garrett, John; Naunheim, Rosanne

Journal of Neuroscience Nursing: April 2019 - Volume 51 - Issue 2 - p 62–66
doi: 10.1097/JNN.0000000000000420

ABSTRACT Objective: Drug and alcohol (DA)–related emergency department (ED) visits represent an increasing fraction the head-injured population seen in the ED. Such patients present a challenge to the evaluation of head injury and determination of need for computed tomographic (CT) scan and further clinical path. This effort examined whether an electroencephalogram (EEG)-based biomarker could aid in reducing unnecessary CT scans in the intoxicated ED population. Method: This is a retrospective secondary study of an independent prospective US Food and Drug Administration validation trial that demonstrated the efficacy of (1) an automatic Structural Injury Classifier for the likelihood of injury visible on a CT (CT+) and (2) an EEG-based Brain Function Index to assess functional impairment in minimally impaired, head-injured adults presenting within 3 days of injury. Impact on the biomarker performance in patients who presented with or without DA was studied. Results: Structural Injury Classifier sensitivity was not significantly impacted by the presence of DA. Although specificity decreased, it remained several times higher than obtained using standard CT decision rules. Furthermore, the potential to reduce the number of unnecessary scans by approximately 30% was demonstrated when the Structural Injury Classifier was integrated into CT clinical triage. The Brain Function Index was demonstrated to be independent of the presence of DA. Conclusion: This EEG-based assessment technology used to identify the likelihood of structural or functional brain injury in mildly head-injured patients represents an objective way to aid in triage patients with DA on presentation, with the potential to decrease overscanning while not sacrificing sensitivity to injuries visible on CT.

J. Stephen Huff, MD, University of Virginia School of Medicine, Charlottesville, VA.

John Garrett, MD, Baylor University Medical Center, Dallas, TX.

Rosanne Naunheim, MD, Washington University Barnes Jewish Medical Center, St Louis, MO.

Questions or comments about this article may be directed to Edward Michelson, MD, at He is a Professor and Chair, Department of Emergency Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX.

The parent study from which this study cohort was derived was funded in part by a research contract from the US Army, contract #W81XWH-14-C-1405.

Dr Michelson sits on the medical advisory board of BrainScope Co, Inc, but receives no financial renumeration for this activity. Drs Huff, Garrett, and Naunheim were principal investigators at clinical data acquisition sites whose institutions received research contracts from BrainScope Co, Inc, to support this study. BrainScope Co, Inc, had no role other than indicated previously in the conduct of these studies. These data used in this study were collected under support in part by a research contract from the US Army, contract #W81XWH-14-C-1405, entitled “Validation of Point-of-Care TBI Detection System for Head Injured Patients,” and by research grants from BrainScope Co, Inc, to the clinical sites.

The views, opinions, and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision, unless so designated by other documentation. In the conduct of research where humans are the subjects, the investigator(s) adhered to the policies regarding the protection of human subjects as prescribed by Code of Federal Regulations Title 45, Volume 1, Part 46; Title 32, Chapter 1, Part 219; and Title 21, Chapter 1, Part 50 (Protection of Human Subjects).

© 2019 American Association of Neuroscience Nurses