Comparison of quantitative electroencephalogram to current clinical decision rules for head computed tomography use in acute mild traumatic brain injury in the ED - 27/02/15

Doi : 10.1016/j.ajem.2014.11.015

Syed Imran Ayaz, MBBS ^a,^{^⁎} , Craig Thomas, MS ^a, Andrew Kulek, BS ^a, Rosa Tolomello, BS ^a, Valerie Mika, MS ^a, Duane Robinson, BA ^a, Patrick Medado, BS ^a, Claire Pearson, MD, MPH ^a, Leslie S. Prichep, PhD ^b, Brian J. O’Neil, MD ^a,^c
^a Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
^b Brain Research Laboratories, Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA
^c Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA

^⁎Corresponding author at: Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St Antoine, UHC 6G, Detroit, MI 48201. Tel.: +1 313 745 3246; fax: +1 313 745 4703.

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Abstract

Study objective

We compared the performance of a handheld quantitative electroencephalogram (QEEG) acquisition device to New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR), and National Emergency X-Radiography Utilization Study II (NEXUS II) Rule in predicting intracranial lesions on head computed tomography (CT) in acute mild traumatic brain injury in the emergency department (ED).

Methods

Patients between 18 and 80 years of age who presented to the ED with acute blunt head trauma were enrolled in this prospective observational study at 2 urban academic EDs in Detroit, MI. Data were collected for 10 minutes from frontal leads to determine a QEEG discriminant score that could maximally classify intracranial lesions on head CT.

Results

One hundred fifty-two patients were enrolled from July 2012 to February 2013. A total 17.1% had acute traumatic intracranial lesions on head CT. Quantitative electroencephalogram discriminant score of greater than or equal to 31 was found to be a good cutoff (area under receiver operating characteristic curve = 0.84; 95% confidence interval [CI], 0.76-0.93) to classify patients with positive head CT. The sensitivity of QEEG discriminant score was 92.3 (95% CI, 73.4-98.6), whereas the specificity was 57.1 (95% CI, 48.0-65.8). The sensitivity and specificity of the decision rules were as follows: NOC 96.1 (95% CI, 78.4-99.7) and 15.8 (95% CI, 10.1-23.6); CCHR 46.1 (95% CI, 27.1-66.2) and 86.5 (95% CI, 78.9-91.7); NEXUS II 96.1 (95% CI, 78.4-99.7) and 31.7 (95% CI, 23.9-40.7).

Conclusion

At a sensitivity of greater than 90%, QEEG discriminant score had better specificity than NOC and NEXUS II. Only CCHR had better specificity than QEEG discriminant score but at the cost of low (<50%) sensitivity.

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Plan

Introduction

Methods

Study design and setting

Selection of participants

Procedures, measurements, and outcomes

Quantitative EEG and statistical analysis

Results

Discussion

Limitations

☆	Source of support: This research was supported in part by funding from BrainScope Company, Inc, which covered expenses related to data acquisition. The device used for electroencephalogram data acquisition is under development by BrainScope Company, Inc.
☆☆	Presented at the Research Forum of the American College of Emergency Physicians Scientific Assembly in Seattle, WA, on October 14, 2013.
★	Disclosure: The authors disclose the following: Leslie S Prichep is a scientific consultant to BrainScope Company, Inc, who provided the funds for this research. Brian J O’Neil discloses that BrainScope sponsored the study at Wayne State University covering technical costs; however, BrainScope did not participate in the data analysis or writing of the manuscript. No other financial relationships were present.