title: Classification algorithms for the identification of structural injury in TBI using brain electrical activity.
abstract: BACKGROUND
  There is an urgent need for objective criteria adjunctive to standard clinical assessment of acute Traumatic Brain Injury (TBI). Details of the development of a quantitative index to identify structural brain injury based on brain electrical activity will be described.
  
  
  METHODS
  Acute closed head injured and normal patients (n=1470) were recruited from 16 US Emergency Departments and evaluated using brain electrical activity (EEG) recorded from forehead electrodes. Patients had high GCS (median=15), and most presented with low suspicion of brain injury. Patients were divided into a CT positive (CT+) group and a group with CT negative findings or where CT scans were not ordered according to standard assessment (CT-/CT_NR). Three different classifier methodologies, Ensemble Harmony, Least Absolute Shrinkage and Selection Operator (LASSO), and Genetic Algorithm (GA), were utilized.
  
  
  RESULTS
  Similar performance accuracy was obtained for all three methodologies with an average sensitivity/specificity of 97.5%/59.5%, area under the curves (AUC) of 0.90 and average Negative Predictive Validity (NPV)>99%. Sensitivity was highest for CT+ cases with potentially life threatening hematomas, where two of three classifiers were 100%.
  
  
  CONCLUSIONS
  Similar performance of these classifiers suggests that the optimal separation of the populations was obtained given the overlap of the underlying distributions of features of brain activity. High sensitivity to CT+ injuries (highest in hematomas) and specificity significantly higher than that obtained using ED guidelines for imaging, supports the enhanced clinical utility of this technology and suggests the potential role in the objective, rapid and more optimal triage of TBI patients.
authors.affiliation: Brain Research Laboratories, Department of Psychiatry, NYU School of Medicine, New York, NY, USA. Electronic address: Leslie.Prichep@nyumc.org.
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Prichep
authors.affiliation: Algorithm Development Department, BrainScope Co., Inc., Bethesda, MD, USA.
authors.forename: Samanwoy
authors.initials: S
authors.lastname: Ghosh Dastidar
authors.affiliation: Algorithm Development Department, BrainScope Co., Inc., Bethesda, MD, USA.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Jacquin
authors.affiliation: Algorithm Development Department, BrainScope Co., Inc., Bethesda, MD, USA.
authors.forename: William
authors.initials: W
authors.lastname: Koppes
authors.affiliation: Algorithm Development Department, BrainScope Co., Inc., Bethesda, MD, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Miller
authors.affiliation: Algorithm Development Department, BrainScope Co., Inc., Bethesda, MD, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Radman
authors.affiliation: Wayne State University, School of Medicine, Department of Emergency Medicine, Detroit, MI, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Neil
authors.affiliation: Washington University School of Medicine, Division of Emergency Medicine, St. Louis, MO, USA.
authors.forename: Rosanne
authors.initials: R
authors.lastname: Naunheim
authors.affiliation: Departments of Emergency Medicine and Neurology, University of Virginia, Charlottesville, VA, USA; Washington University School of Medicine, Division of Emergency Medicine, St. Louis, MO, USA.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Huff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D001930:Brain Injuries / Q000473:pathology* / Q000503:physiopathology*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Acute traumatic brain injury; CT+ TBI; Classifier algorithms; Electrophysiology of TBI; Genetic algorithms; Quantitative brain activity; Structural brain injury; TBI; TBI triage