Bressan Silvia, Daverio Marco, Martinolli Francesco, Dona' Daniele, Mario Federica, Steiner Ivan P, Dalt Liviana Da
Childs Nerv Syst. 2014 Mar;30(3):477-84. doi: 10.1007/s00381-014-2368-9.
A handheld device using near-infrared technology(Infrascanner) has shown good accuracy for detection of traumatic intracranial haemorrhages in adults. This study aims to determine the feasibility of use of Infrascanner in children with minor head injury (MHI) in the Emergency Department(ED). Secondary aim was to assess its potential usefulness to reduce CT scan rate.
Prospective pilot study conducted in two paediatric EDs, including children at high or intermediate risk for clinically important traumatic brain injury (ciTBI) according to the adapted PECARN rule in use. Completion of Infrascanner measurements and time to completion were recorded. Decision on CT scan and CT scan reporting were performed independently and blinded to Infrascanner results.
Completion of the Infrascanner measurement was successfully achieved in 103 (94 %) of 110 patients enrolled,after a mean of 4.4±2.9 min. A CT scan was performed in 18(17.5 %) children. Only one had an intracranial haemorrhage that was correctly identified by the Infrascanner. The exploratory analysis showed a specificity of 93 % (95 % CI, 86.5–96.6) and a negative predictive value of 100 % (95 % CI,81.6–100) for ciTBI. The use of Infrascanner would have led to avoid ten CT scan, reducing the CT scan rate by 58.8 %.
Infrascanner seems an easy-to-use tool for children presenting to the ED following a MHI, given the high completion rate and short time to completion. Our preliminary results suggest that Infrascanner is worthy of further investigation as a potential tool to decrease the CT scan rate in children with MHI.
一种使用近红外技术的手持设备（Infrascanner）已显示出在检测成人创伤性颅内出血方面具有良好的准确性。本研究旨在确定在急诊科（ED）对轻度头部损伤（MHI）儿童使用Infrascanner的可行性。次要目的是评估其降低CT扫描率的潜在效用。
在两个儿科急诊科进行前瞻性试点研究，纳入根据适用的PECARN规则具有临床重要性创伤性脑损伤（ciTBI）高风险或中度风险的儿童。记录Infrascanner测量的完成情况和完成时间。CT扫描的决策和CT扫描报告是独立进行的，且对Infrascanner结果不知情。
在纳入的110例患者中，103例（94%）成功完成了Infrascanner测量，平均用时4.4±2.9分钟。18例（17.5%）儿童进行了CT扫描。只有1例颅内出血被Infrascanner正确识别。探索性分析显示，对于ciTBI，特异性为93%（95%CI，86.5–96.6），阴性预测值为100%（95%CI，81.6–100）。使用Infrascanner可避免10次CT扫描，使CT扫描率降低58.8%。
鉴于Infrascanner的高完成率和短完成时间，它似乎是一种适用于MHI后到急诊科就诊儿童的易于使用工具。我们的初步结果表明，Infrascanner作为降低MHI儿童CT扫描率的潜在工具值得进一步研究。
