title: 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.
authors.affiliation: Department of Critical Care Medicine, Children’s Hospital of Pittsburgh of the UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, USA. saloniar@upmc.edu
authors.forename: Rosanne
authors.initials: R
authors.lastname: Salonia
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000175:diagnosis*; D008297:Male; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared / Q000379:methods*
references.citation: J Clin Neurosci. 2005 Apr;12(3):291-5
references.pmid: 15851084
references.citation: Lancet. 2009 Oct 3;374(9696):1160-70
references.pmid: 19758692
references.citation: J Biomed Opt. 1997 Jan;2(1):31-41
references.pmid: 23014820
references.citation: Curr Opin Crit Care. 2008 Apr;14(2):135-41
references.pmid: 18388674
references.citation: Pediatrics. 2002 Feb;109(2):E31
references.pmid: 11826241
references.citation: Pediatrics. 1999 Oct;104(4 Pt 1):861-7
references.pmid: 10506226
references.citation: Pediatr Radiol. 1990;20(4):236-40
references.pmid: 2186343
references.citation: J Neurotrauma. 2007 Jan;24(1):75-86
references.pmid: 17263671
references.citation: J Neurotrauma. 2010 Sep;27(9):1597-604
references.pmid: 20568959
references.citation: Pediatrics. 2001 May;107(5):983-93
references.pmid: 11331675
references.citation: Neurosurgery. 1994 May;34(5):840-5; discussion 845-6
references.pmid: 8052380
references.citation: Pediatr Pulmonol. 1998 Dec;26(6):389-95
references.pmid: 9888213
references.citation: J Neurosurg. 1995 Sep;83(3):438-44
references.pmid: 7666220
references.citation: J Neurotrauma. 1995 Aug;12(4):591-600
references.pmid: 8683610
references.citation: J Biomed Opt. 2000 Apr;5(2):206-13
references.pmid: 10938785
references.citation: Childs Nerv Syst. 2000 Jan;16(1):25-33; discussion 34
references.pmid: 10672426
references.citation: CMAJ. 2010 Mar 9;182(4):341-8
references.pmid: 20142371
references.citation: J Neurotrauma. 2007 Jan;24(1):54-74
references.pmid: 17263670
references.citation: J Neurosurg. 1993 Jul;79(1):43-7
references.pmid: 8315468
references.citation: Mol Diagn Ther. 2008;12(6):345-58
references.pmid: 19035622
references.citation: J Trauma. 2006 Dec;61(6):1480-3
references.pmid: 17159695
references.citation: Pediatr Res. 2009 Jan;65(1):97-102
references.pmid: 18787505
references.citation: AJR Am J Roentgenol. 2001 Feb;176(2):289-96
references.pmid: 11159059