Comparison of quantitative EEG to current clinical decision rules for head CT use in acute mild traumatic brain injury in the ED.
OBJECTIVE
We compared the performance of a handheld quantitative electroencephalogram (QEEG) acquisition device to New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR), and National Emergency X-Radiography Utilization Study II (NEXUS II) Rule in predicting intracranial lesions on head computed tomography (CT) in acute mild traumatic brain injury in the emergency department (ED).


METHODS
Patients between 18 and 80 years of age who presented to the ED with acute blunt head trauma were enrolled in this prospective observational study at 2 urban academic EDs in Detroit, MI. Data were collected for 10 minutes from frontal leads to determine a QEEG discriminant score that could maximally classify intracranial lesions on head CT.


RESULTS
One hundred fifty-two patients were enrolled from July 2012 to February 2013. A total 17.1% had acute traumatic intracranial lesions on head CT. Quantitative electroencephalogram discriminant score of greater than or equal to 31 was found to be a good cutoff (area under receiver operating characteristic curve = 0.84; 95% confidence interval [CI], 0.76-0.93) to classify patients with positive head CT. The sensitivity of QEEG discriminant score was 92.3 (95% CI, 73.4-98.6), whereas the specificity was 57.1 (95% CI, 48.0-65.8). The sensitivity and specificity of the decision rules were as follows: NOC 96.1 (95% CI, 78.4-99.7) and 15.8 (95% CI, 10.1-23.6); CCHR 46.1 (95% CI, 27.1-66.2) and 86.5 (95% CI, 78.9-91.7); NEXUS II 96.1 (95% CI, 78.4-99.7) and 31.7 (95% CI, 23.9-40.7).


CONCLUSIONS
At a sensitivity of greater than 90%, QEEG discriminant score had better specificity than NOC and NEXUS II. Only CCHR had better specificity than QEEG discriminant score but at the cost of low (<50%) sensitivity.
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA. Electronic address: sayaz@med.wayne.edu.
Syed Imran
SI
Ayaz
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Craig
C
Thomas
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Andrew
A
Kulek
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Rosa
R
Tolomello
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Valerie
V
Mika
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Duane
D
Robinson
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Patrick
P
Medado
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Claire
C
Pearson
Brain Research Laboratories, Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
Leslie S
LS
Prichep
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA; Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Brian J
BJ
O'Neil
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D003661:Decision Support Techniques; D004569:Electroencephalography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*