Intracranial Hematoma Detection by Near Infrared Spectroscopy in a Helicopter Emergency Medical Service: Practical Experience

Abstract

In (helicopter) emergency medical services, (H)EMS, the prehospital detection of intracranial hematomas should improve patient care and the triage to specialized neurosurgical hospitals. Recently, noninvasive detection of intracranial hematomas became possible by applying transcranial near infrared spectroscopy (NIRS). Herein, second-generation devices are currently available, for example, the Infrascanner 2000 (Infrascan), that appear suited also for prehospital (H)EMS applications. Since (H)EMS operations are time-critical, we studied the Infrascanner 2000 as a “first-time-right” monitor in healthy volunteers (n = 17, hospital employees, no neurologic history). Further, we studied the implementation of the Infrascanner 2000 in a European HEMS organization (Lifeliner 1, Amsterdam, The Netherlands). The principal results of our study were as follows: The screening for intracranial hematomas in healthy volunteers with first-time-right intention resulted in a marked rate of virtual hematomas (false positive results, i.e., 12/17), rendering more time consuming repeat measurements advisable. The results of the implementation of the Infrascanner in HEMS suggest that NIRS-based intracranial hematoma detection is feasible in the HEMS setting. However, some drawbacks exist and their possible solutions are discussed. Future studies will have to demonstrate how NIRS-based intracranial hematoma detection will improve prehospital decision making in (H)EMS and ultimately patient outcome.

Investigation of the source‐detector separation in near infrared spectroscopy for healthy and clinical applications

“…At the presence of hematoma, the high absorption of blood within the hematoma made it harder for photons to pass through to the brain tissue and resulted in higher sensitivity to superficial layers. NIRS products available in market have been tested to prove the ability to detect cerebral hematoma , all with SDS greater than 25 mm.…”

“…Numerous applications of NIRS technology in the assessment of brain function under various clinical conditions caused by traumatic brain injury (TBI) or stroke indicate the importance of study and evaluation of light tissue interaction under such conditions . Applying various types of clinically relevant changes in the brain such as intracranial hematoma development on a digital model could effectively help in predicting the photon path during measurements with a NIRS device, improving the diagnosis of brain injury.…”

Near‐infrared spectroscopy monitoring in a pre‐hospital trauma patient cohort: An analysis of successful signal collection

“…The proportion of pre-hospital time with successful monitoring (>70%) was 71.4% (45 of 63) for all three sensors, with at least two sensors functional in 90.4% (57 of 63). The median (interquartile range) scene time was 19 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) minutes in patients with NIRS monitoring compared to 18 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) minutes without NIRS monitoring (P = .570). There was no difference in the median (interquartile range) total pre-hospital time between patients with or without monitoring sensors (72 [59-89] versus 72 [59-80] minutes; P = .605).…”

“…9 However, recent feasibility studies in a pre-hospital HEMS setting showed high false-positive rates for haematoma detection. 24 A recent pilot study assessing technical feasibility in patients requiring pre-hospital anaesthesia showed that almost all (29/31) patients had successful NIRS monitoring signals from anaesthesia induction to hospital arrival. 25 Promising in-hospital uses in the setting of brain injury have been dependent on consistent signals coupled with multiple invasive measurements which are not currently available in pre-hospital care.…”

Fast localization method of an anomaly in tissue based on differential optical density

“…These methods have been applied in many fields such as tumor detection [1], brain imaging [2,3] and brain hematoma detection [4][5][6][7], and are gradually being applied to clinical detection. Based on multiple-source and multiple-detector patterns, using the tissue optical parameter reconstruction (Diffuse Optical Tomography, DOT) the three-dimensional distribution of the optical parameters of the tissue can be obtained in order to achieve the identification of tumors [8], hemoglobin distribution and other imaging tasks.…”