Evaluation of near infrared spectroscopy as screening tool for detecting intracranial hematomas in patients with traumatic brain injury

Background: Traumatic Brain Injury (TBI) is one of the most common surgical emergencies in service hospitals of India. Computed tomography (CT) has been a consistent and reliable technique for detecting intracranial hemorrhages but is limited by its non-availability in most service hospitals. Therefore the need for a cheaper, portable and easily available option required to be explored. The aim of this study was to determine the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of Near Infra Red Spectroscopy (NIRS) against the gold standard of NCCT head.

Methods: An observational, prospective study was conducted in 100 patients of closed head injury, attending the emergency department or surgical OPD of a service zonal hospital with NIRS. All these patients were subsequently subjected to NCCT head. Sensitivity, specificity, and positive and negative predictive values of NIRS were calculated. The study was conducted from Oct 2010 to Jul 2012.

Results: All the 100 patients were evaluated with NIRS and subsequently subjected to NCCT head. The results were compiled and statistical analysis of the same was conducted. The data revealed a sensitivity of 58.46%, a specificity of 42.86%, a positive predictive value of 65.52% and a negative predictive value of 35.71%.

Conclusion: Near Infra Red Spectroscopy (NIRS) is a good screening tool for prediction of intra cerebral haemorrhage in the field and even intensive care units. This was the first study of its kind in the Indian subcontinent and the results suggest that NIRS is a good device to predict intracranial subdural and epidural haematomas. It is however not superior to computer tomography and magnetic resonance imaging.