title: Increased prognostic accuracy of TBI when a brain electrical activity biomarker is added to loss of consciousness (LOC).
abstract: BACKGROUND
  Extremely high accuracy for predicting CT+ traumatic brain injury (TBI) using a quantitative EEG (QEEG) based multivariate classification algorithm was demonstrated in an independent validation trial, in Emergency Department (ED) patients, using an easy to use handheld device. This study compares the predictive power using that algorithm (which includes LOC and amnesia), to the predictive power of LOC alone or LOC plus traumatic amnesia.
  
  
  METHODS
  ED patients 18-85years presenting within 72h of closed head injury, with GSC 12-15, were study candidates. 680 patients with known absence or presence of LOC were enrolled (145 CT+ and 535 CT- patients).
  
  
  METHODS
  5-10min of eyes closed EEG was acquired using the Ahead 300 handheld device, from frontal and frontotemporal regions. The same classification algorithm methodology was used for both the EEG based and the LOC based algorithms. Predictive power was evaluated using area under the ROC curve (AUC) and odds ratios.
  
  
  RESULTS
  The QEEG based classification algorithm demonstrated significant improvement in predictive power compared with LOC alone, both in improved AUC (83% improvement) and odds ratio (increase from 4.65 to 16.22). Adding RGA and/or PTA to LOC was not improved over LOC alone.
  
  
  CONCLUSIONS
  Rapid triage of TBI relies on strong initial predictors. Addition of an electrophysiological based marker was shown to outperform report of LOC alone or LOC plus amnesia, in determining risk of an intracranial bleed. In addition, ease of use at point-of-care, non-invasive, and rapid result using such technology suggests significant value added to standard clinical prediction.
authors.affiliation: Brain Health, Sevierville, TN, USA.
authors.forename: Dallas
authors.initials: D
authors.lastname: Hack
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Huff
authors.affiliation: Iatrikos Research and Development Strategies, LLC, Tampa, FL, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Curley
authors.affiliation: Washington University Barnes Jewish Medical Center, St. Louis, MO, USA.
authors.forename: Roseanne
authors.initials: R
authors.lastname: Naunheim
authors.affiliation: BrainScope Co., Bethesda, MD, USA.
authors.forename: Samanwoy
authors.initials: S
authors.lastname: Ghosh Dastidar
authors.affiliation: BrainScope Co., Bethesda, MD, USA; New York University School of Medicine, Department of Psychiatry, New York, NY, USA. Electronic address: leslie.prichep@nyumc.org.
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Prichep
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000647:Amnesia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000150:complications / Q000503:physiopathology*; D055815:Young Adult
keywords: EEG; LOC; Loss of consciousness; TBI; Traumatic amnesia; Traumatic brain injury