Currently, traumatic brain injury is managed uniformly. The pre-hospital data field does not specify the type of brain injury, if any. Hence all such patients receive the same treatment (usually intubation, and transfer to a neurosurgical unit). On scene diagnosis of injury would permit more directed therapies to be initiated. It is vital to dispatch resources appropriate for the presumed severity of injury. Currently dispatch criteria are often based on “Mechanism of Injury” (e.g. fall > 2 floors, ejected from car) and interrogation of callers.
Here below there are a number of studies looking at improving this aspect:
2.1 Automated prediction of injury in Road Traffic Collisions
(RTCs)TRL (https://trl.co.uk) accumulate comprehensive data from RTCs. This includes on board gyroscope sensors and cameras which many cars now have. A combined Imperial and TRL PhD student is currently modelling the patterns of brain injury from such data. This may, in the future, enable prediction of severity of injuries from such data at the time of the incident and activate the appropriate emergency response automatically.
2.2 Instant-on-Scene Video Triage (London Ambulance Service and GoodSAM)
With mobile phone technology, visualising the scene and patient can help dispatch decisions. We are currently undertaking a pilot study with London Ambulance Service as to the benefit of on scene video from Incident Response Officers (IROs) and the public.
2.3 On Scene Imaging (Imperial, London’s Air Ambulance, Infrascanner)
Knowing the nature of an injury could help decision making – do you bypass the nearest hospital to go an additional hour to the neurosurgical centre? This is especially important in remote regions such as East Anglia where travel times can be long. More importantly, earlier diagnosis would enable condition-targeted treatments. Diagnosis can either be anatomically based (with imaging) or “likelihood” based with biomarkers.
With London’s Air Ambulance and Imperial, we have undertaken a HTC funded pilot study into the use of a single channel Near Infra-Red Spectroscopy (NIRS) machine (Infrascanner) and its ability to reliably detect extra-axial haematoma in the hyperacute setting. Our results demonstrate reasonable sensitivity and specificity in hospital use, but moderate sensitivity and poor specificity in pre-hospital application.
At Imperial, we currently use a 48 channel NIRS machine to study spreading cortical depolarisations. Such a device overcomes many of the limitations of a single channel NIRS device. We are preparing a grant application with Clare Elwell’s group at UCL to miniaturise such a device for pre-hospital use.