使用便携式近红外光谱设备检测儿童颅内创伤性血肿。
Intracranial Traumatic Hematoma Detection in Children Using a Portable Near-infrared Spectroscopy Device.
机构信息
Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania.
Children's Hospital of Philadelphia, Division of Neurology, Philadelphia, Pennsylvania.
出版信息
West J Emerg Med. 2021 Mar 24;22(3):782-791. doi: 10.5811/westjem.2020.11.47251.
INTRODUCTION
We sought to validate a handheld, near-infrared spectroscopy (NIRS) device for detecting intracranial hematomas in children with head injury.
METHODS
Eligible patients were those <18 years old who were admitted to the emergency department at three academic children's hospitals with head trauma and who received a clinically indicated head computed tomography (HCT). Measurements were obtained by a blinded operator in bilateral frontal, temporal, parietal, and occipital regions. Qualifying hematomas were a priori determined to be within the brain scanner's detection limits of >3.5 milliliters in volume and <2.5 centimeters from the surface of the brain. The device's measurements were positive if the difference in optical density between hemispheres was >0.2 on three successive scans. We calculated diagnostic performance measures with corresponding exact two-sided 95% Clopper-Pearson confidence intervals (CI). Hypothesis test evaluated whether predictive performance exceeded chance agreement (predictive Youden's index > 0).
RESULTS
A total of 464 patients were enrolled and 344 met inclusion for primary data analysis: 10.5% (36/344) had evidence of a hematoma on HCT, and 4.7% (16/344) had qualifying hematomas. The handheld brain scanner demonstrated a sensitivity of 58.3% (21/36) and specificity of 67.9% (209/308) for hematomas of any size. For qualifying hematomas the scanner was designed to detect, sensitivity was 81% (13/16) and specificity was 67.4% (221/328). Predictive performance exceeded chance agreement with a predictive Youden's index of 0.11 (95% CI, 0.10 - 0.15; P < 0.001) for all hematomas, and 0.09 (95% CI, 0.08 - 0.12; P < 0.001) for qualifying hematomas.
CONCLUSION
The handheld brain scanner can non-invasively detect a subset of intracranial hematomas in children and may serve an adjunctive role to head-injury neuroimaging decision rules that predict the risk of clinically significant intracranial pathology after head trauma.
介绍
我们旨在验证一款手持式近红外光谱（NIRS）设备，以检测外伤性颅内血肿患儿的颅内血肿。
方法
符合条件的患者为年龄<18 岁，因头部外伤收入 3 家学术性儿童医院急诊，且均接受临床指征的头部计算机断层扫描（HCT）检查。由一位盲法操作者在双侧额、颞、顶和枕区进行测量。合格的血肿是根据先前确定的标准，血肿体积>3.5 毫升且距大脑表面<2.5 厘米。如果三个连续扫描的半球间光密度差值>0.2，则设备测量结果为阳性。我们用相应的精确双侧 95% Clopper-Pearson 置信区间（CI）计算诊断性能指标。假设检验评估预测性能是否超过偶然一致性（预测 Youden 指数>0）。
结果
共纳入 464 例患者，其中 344 例符合主要数据分析的纳入标准：10.5%（36/344）HCT 有血肿证据，4.7%（16/344）有合格血肿。手持式脑部扫描仪对任何大小血肿的敏感性为 58.3%（21/36），特异性为 67.9%（209/308）。对于设计用于检测的合格血肿，扫描仪的敏感性为 81%（13/16），特异性为 67.4%（221/328）。预测性能超过偶然一致性，所有血肿的预测 Youden 指数为 0.11（95%CI，0.10-0.15；P<0.001），合格血肿的预测 Youden 指数为 0.09（95%CI，0.08-0.12；P<0.001）。
结论
手持式脑部扫描仪可无创性检测儿童颅内血肿的一部分，可能有助于外伤性颅脑损伤神经成像决策规则，预测颅脑外伤后临床显著颅内病变的风险。
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