The Utility of Near Infrared Spectroscopy in Detecting Intracranial Hemorrhage in Children

Abstract

A prospective case-control study was conducted in a tertiary care pediatric intensive care unit (PICU) to evaluate the use of near infrared spectroscopy (NIRS) for the detection of intracranial hemorrhage (ICH) in children. Subjects 0-14 years of age who had a computed tomography (CT) scan of the head performed as part of clinical care were eligible for enrollment. The children were stratified into two groups based on whether the CT was normal or abnormal. Children in the abnormal imaging cohort were further divided into those with ICH and those with other abnormalities of the brain parenchyma (contusions, diffuse axonal injury [DAI], or cerebral edema) or fractures. NIRS measurements were performed on all subjects within 24 h of head CT. The NIRS operator was blinded to the presence or absence of ICH. NIRS measurements were performed in eight different scalp locations (four bilaterally). A total of 103 measurements were made. The optical density (OD) was automatically calculated by comparing the reflected and diffused optical signal. A ΔOD>0.2 between hemispheres in any scalp location was considered abnormal. NIRS was performed in a total of 28 subjects: 7 had normal imaging and 21 had abnormal imaging. Of those with abnormal imaging, 12 had ICH. The sensitivity and specificity of NIRS at detecting ICH was 1.0 and 0.8, respectively. The positive and negative predictive values were 0.8 and 1.0, respectively. In conclusion, NIRS correctly identified all cases of ICH in this pilot study. Our preliminary results suggest that NIRS may be beneficial in the evaluation of a child with possible ICH.

Near-Infrared Spectroscopy in the Monitoring of Adult Traumatic Brain Injury: A Review

“…Fifty-nine patients in this cohort developed a secondary hematoma, with 93% (n = 55) of these cases identified by a positive DOD. Other similar investigations support these levels of sensitivity at * 90%, 30,31 with Salonia and coworkers 34 producing similarly sensitive and specific data in pediatric cases. NIRS, therefore, has exciting potential as a bedside screening tool for those individuals admitted after TBI to be observed for the development of secondary mass lesions, particularly if clinical examination is impractical because of sedation/general anesthesia, and if avoiding invasive intracranial monitoring is desired.…”

“…28 The profound effect that the presence of hematomas or intracranial mass lesions can have on the cerebral NIRS parameters yielded within the context of TBI has led to this modality being examined as a screening tool for the presence of these lesions since the early 1990s. [29][30][31][32][33][34] Primarily, these investigations examined the mean difference in optical density between each cerebral hemisphere (DOD) as a means of localizing pathology or predicting the presence of a localized hematoma or mass lesion. Within this area of study, work conducted by Robertson and coworkers 31 examined parameters retrieved from > 300 patients under observation after sustaining a TBI.…”

“…Unfortunately, as with many other monitoring modalities within the field of brain injury medicine, there is very limited evidence to support the ability of NIRS to predict outcome after injury. Although frequently referred to in limited clinical investigations, [17][18][19][29][30][31][32][33][34][35][36][37] no substantial prospective investigation provides useful information regarding how NIRS parameters can be used to predict the eventual impact of a particular injury. This in particular provides an opportunity for very meaningful investigations to be undertaken in the future.…”

Intracranial hemorrhage alters scalp potential distribution in bioimpedance cerebral monitoring: Preliminary results from FEM simulation on a realistic head model and human subjects

“…Therefore, a fast and portable device that could accurately detect the presence or absence of ICH, regardless of its ability to additionally provide detailed anatomical localization, would have clear clinical applications for (i) the identification and triage of ICH patients for hospital transport prioritization [14][15][16][17][18] and (ii) continuous monitoring of inpatients after ischemic stroke or neurosurgical procedures, to identify new onset or increased ICH in real time and expedite more detailed imaging and management. [19][20][21] Recent studies showed that near-infrared spectroscopy (NIRS) has potential as a portable diagnostic device to identify SDH and EDH rapidly because both occur superficial to the brain surface, [22][23][24] but NIRS cannot identify deep hemorrhages such as IPH and IVH. 25 A portable device that could identify both superficial and deep hemorrhages therefore represents an unmet need for ICH screening.…”

NIR light propagation in a digital head model for traumatic brain injury (TBI)

“…NIRS technology is also becoming smaller and more transportable for field use [34,35]. NIRS imaging has previously been developed for detecting intracranial hematomas based on the global optical density differences from a region on the head where there is a hematoma compared to a region where there is no hematoma [35][36][37][38][39][40][41]. One issue with this method is that in blunt trauma brain injury, when a patient is hit on one side of the head, a bruise or swelling appears on the side of the head that is hit and an intracranial hematoma may occur on the opposite side of the head, where the brain collides with the inside of the skull [42].…”