Detection of intracranial hematomas in the emergency department using near infrared spectroscopy.

Hypothesis: Traumatic brain injury (TBI) is one of the most important causes of morbidity and mortality in our society. The development of near infrared technology for the detection of intracranial hematomas may assist earlier diagnosis of TBI. This in turn may enable earlier targeted treatments minimizing the harm and subsequent social and economic effects of TBI. Methods: A handheld, noninvasive Near Infrared Spectroscopy device, Infrascanner 2000, (Infrascan Inc., Philadelphia, PA, USA) was used in a major trauma center to screen for traumatic intracranial hematomas. The Infrascanner was used successfully in 205 patients on their arrival in the emergency department prior to CT head. Results: In the whole cohort, sensitivity was 75%, specificity was 50.43%, with negative predictive value 72.84%, and positive predictive value 53.23%. In 45 patients, where the volume of blood was >3.5mL, the sensitivity was 89.36%, specificity 48.73% with negative predictive value 93.9% and positive predictive value 34.15%. Conclusions: The Infrascanner has a relatively high specificity and negative predictive value; therefore, it could in association with the Neurological examination, help in the triage of the trauma patient with potential brain injury. Further investigation is necessary to determine the use of Infrascanner 2000 as a diagnostic method in TBI.

Case series of posterior instrumentation for repair of burst lumbar vertebral body fractures with entrapped neural elements.

BACKGROUND: Burst fractures of the lumbar vertebrae and laminar fractures associated with dural tears and entrapment of neural elements have been reported in the past as a relatively rare occurrence. To the best of our knowledge, there is no consensus on the approach to repairing these types of fractures. The objective of this study is to describe a method of repair for traumatic burst fractures of the lumbar spine and vertical laminar fractures associated with entrapped neural elements. METHODS: Seventeen patients with lumbar burst fractures were treated from June 2015 through April 2017. Dural tear was detected in all cases included in this study (confirmed intra-operatively). All other burst fractures were excluded. In all cases, unilateral posterior fixation was performed with no distraction initially. The spinal canal was then decompressed; and the entrapped neural elements released. Formal distraction was performed after canal decompression to allow for ligamentotaxis, followed by reduction of the retropulsed fractured segments back into the vertebral body. RESULTS: Using this method we achieved satisfactory results in that none of the patients had further deterioration of neurological deficit and the fixation allowed for early mobilization. Continued improvement was seen at the time of follow up for each of the studied patients with improved neurology, pain and no CSF leak. CONCLUSIONS: Our institution has demonstrated successful use of a posterior instrumentation, spinal canal decompression, release of entrapped nerve roots, and reduction of the retropulsed segment, in patients with traumatic burst fracture of the lumbar vertebrae complicated by entrapped neural elements.

Case report on the spontaneous resolution of a traumatic intracranial acute subdural haematoma: evaluation of the guidelines.

Rapid spontaneous resolution of traumatic acute subdural haematomas (ASDH) can occur but is rare. We present an 88-year-old female who presents with a large left acute subdural haematoma (ASDH) measuring 18 mm in thickness with midline shift of 10.7 mm. We managed her conservatively based upon good consciousness level and absent neurological deficits. Repeat computed tomography (CT) the following day demonstrated near complete resolution of the ASDH and midline shift regression; a further CT confirmed resolution. Most patients with large ASDH require surgical evacuation; however, in rare cases, they can resolve spontaneously with extreme rapidity. Conservative management can be a valid option in carefully selected cases.

Near-infrared spectroscopy (NIRS) to detect traumatic intracranial haematoma: A systematic review and meta-analysis.

OBJECTIVES AND METHODS: Head injury is the most common trauma presentation to UK emergency departments, with around 1.2 million patients each year. The key management principal for this time critical illness remains early surgical intervention. With the development of handheld near-infrared spectroscopy (NIRS) devices, there is now the possibility of triaging and diagnosing these patients immediately, where computed tomography (CT) scanner is unavailable. NIRS has two related but distinct potential uses within clinical medicine. Firstly, as a triage tool both in hospital and prehospital settings by doctors, nurses or paramedics as determined by its negative predictive value (NPV). Secondly, as a diagnostic aid as determined by its positive predictive value (PPV). The aim of this systematic review and meta-analysis is therefore to interrogate the current literature on NIRS in detecting intracranial haematomas. RESULTS: NIRS technology has a cross-study sensitivity of 78%, specificity of 90%, PPV of 77%, and a NPV of 90%, which does not meet current standards as a diagnostic/triage tool in the populations studied. Additionally, its use is limited to those without extracranial injuries and may also be complicated by long scan times. CONCLUSION: Larger and more heterogeneous studies are required for specifically evaluating NIRS performance in detecting intracranial lesions requiring emergency evacuation.