Application of a Near-infrared Spectroscope by an Extreme Forward Medical Team for the Triage of Casualties With Traumatic Brain Injury
© The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND: During deployment of military medical teams similarly to prehospital practice, without immediate computed tomography scan access, identifying patients requiring neuro-specific care to manage pragmatic triage proves crucial. We assessed the contribution of this portable near-infrared spectroscope (NIRS) handheld device, Infrascanner Model 2000 (InfraScan Inc.; Philadelphia, PA), to screen patients suspected to require specific neurosurgical care.
MATERIALS AND METHODS: This single-center retrospective analysis was based on the data from the medical records of the traumatic brain injured patients. We analyzed all the patients strictly over 18 years old presenting a clinical history of traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) < 15.
RESULTS: Thirty-seven medical records of patients admitted for TBI met the inclusion criteria for our analysis. The median GCS was 9 [3-14]. Eight patients (21.6%) underwent neurosurgery and 25 (67.6%) required intensive care unit (ICU) admission, after initial assessment and resuscitation. The NIRS was the most sensible to detect intracranial hematoma (n = 21), intracranial hematoma leading to surgery (n = 8), and intracranial hematoma leading to admission in ICU (n = 25). Its negative predictive value was 100% regarding hematomas leading to surgery. False-positive results were encountered in 10 cases (27.0%). Excluding cases harboring confounding extracranial hematomas, parietal area was still the most represented (n = 3).
CONCLUSION: The NIRS was relevant to detect hematoma leading to prompt surgery in our study. The lack of specificity in a nonselected cohort of patients underlines the need to associate simple clinical feature such as neurological deficit and NIRS results to perform rational triage.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:188 |
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| Enthalten in: |
Military medicine - 188(2023), 3-4 vom: 20. März, Seite e572-e578 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Joubert, Christophe [VerfasserIn] |
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| Anmerkungen: |
Date Completed 22.03.2023 Date Revised 12.04.2023 published: Print ErratumIn: Mil Med. 2022 Dec 22;:. - PMID 36548462 Citation Status MEDLINE |
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| doi: |
10.1093/milmed/usac306 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM347575153 |
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| 500 | |a Date Revised 12.04.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a ErratumIn: Mil Med. 2022 Dec 22;:. - PMID 36548462 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: During deployment of military medical teams similarly to prehospital practice, without immediate computed tomography scan access, identifying patients requiring neuro-specific care to manage pragmatic triage proves crucial. We assessed the contribution of this portable near-infrared spectroscope (NIRS) handheld device, Infrascanner Model 2000 (InfraScan Inc.; Philadelphia, PA), to screen patients suspected to require specific neurosurgical care | ||
| 520 | |a MATERIALS AND METHODS: This single-center retrospective analysis was based on the data from the medical records of the traumatic brain injured patients. We analyzed all the patients strictly over 18 years old presenting a clinical history of traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) < 15 | ||
| 520 | |a RESULTS: Thirty-seven medical records of patients admitted for TBI met the inclusion criteria for our analysis. The median GCS was 9 [3-14]. Eight patients (21.6%) underwent neurosurgery and 25 (67.6%) required intensive care unit (ICU) admission, after initial assessment and resuscitation. The NIRS was the most sensible to detect intracranial hematoma (n = 21), intracranial hematoma leading to surgery (n = 8), and intracranial hematoma leading to admission in ICU (n = 25). Its negative predictive value was 100% regarding hematomas leading to surgery. False-positive results were encountered in 10 cases (27.0%). Excluding cases harboring confounding extracranial hematomas, parietal area was still the most represented (n = 3) | ||
| 520 | |a CONCLUSION: The NIRS was relevant to detect hematoma leading to prompt surgery in our study. The lack of specificity in a nonselected cohort of patients underlines the need to associate simple clinical feature such as neurological deficit and NIRS results to perform rational triage | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Beucler, Nathan |e verfasserin |4 aut | |
| 700 | 1 | |a Desse, Nicolas |e verfasserin |4 aut | |
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| 700 | 1 | |a Dulou, Renaud |e verfasserin |4 aut | |
| 700 | 1 | |a Dagain, Arnaud |e verfasserin |4 aut | |
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