By Jane Ehrhardt
A new diagnostic tool opens the door for physicians to identify minor brain injuries and concussions in minutes. “It gets patients the answers faster and gets them home quicker. They love that,” says Mark Christensen, MD, emergency department medical director at Cullman Regional Medical Center.
Cullman is the first hospital in the Southeast to use the BrainScope. They were part of the pilot program, but during the pandemic head injuries became less common in the emergency room with the end of sports and group activities. Now their ER sees several cases a week with that number growing as word spreads about this unique diagnostic tool.
“This is the first of its kind,” Christensen says. “It’s is a modification on the electroencephalogram (EEG). Certain brainwave patterns present if there’s internal injury to the brain, like a bleed or skull fracture, which is why we did CT scans on patients anyway.”
On this device, a lightweight disposable headset lined with seven plastic electrodes attaches to the forehead, temples, and each earlobe. The manufacturer says the reading takes up to 20 minutes, but Christensen says it’s closer to five and as low as three minutes. An EEG, on the other hand, would usually take 45 minutes and require a neurologist to interpret the results. CT scans can take hours of waiting and then waiting again for the radiologist to study the data. And neither diagnoses a concussion.
BrainScope delivers the results on a handheld device in a straightforward manner any healthcare worker could understand. The screen displays positive or negative for each of the available conditions: internal injury and concussion.
A positive result for internal injury means the brainwave pattern signaled the likelihood of bleeding in the brain. “BrainScope can detect as little as 1cc of blood in the brain, which is as sensitive as a CT scan with a proven 99 percent accuracy,” Christensen says.
The device diagnoses concussion the same way. The brainwaves run through Brainscope’s artificial intelligence utilizing multiple algorithms to compare the patient’s brain patterns to a database of over 10,000 cases. The comparison takes into account biomarkers as well, including gender, age, type of injury, loss of consciousness, and whether the incident was witnessed.
For concussions, the device presents additional insights into the condition beyond positive or negative. A brain function index scale displays a percentile reflecting a range from normal to abnormal. A third screen presents a concussion index (CI) ranking up to 100. “Lower is more severe,” Christensen says. “Physicians can also track that CI over time by retesting to monitor how the patient is progressing and their readiness to return to work, sports or other activities.”
Recovering from a concussion can be a tough road. Some people struggle with insomnia keeping them up for days at a time, while others face panic attacks, brain fog, and headaches. Full recovery can take 24 hours or several months. “Concussion is not just a mild thing. It’s about time we have a tool to identify it now in the emergency rooms,” Christensen says. “We’re really excited.”
Cullman’s data mirrored BrainScope’s national results to show a 30 percent reduction in the use of head CT scans in ERs after using the device to triage head injuries initiating, which saved those patients from unnecessary radiation exposure as well. That reduction also equated to a 40 percent decrease in the length of stay in the ER for those patients with mild head injuries. “And the patients are much happier, because we can show them results,” Christensen says.
Before BrainScope, no diagnostic tool existed for concussion. CAT scans only look for injuries like skull fractures or bleeds. So ER physicians would examine the patient and report to the worried parents or patients that no CAT scan was needed but that they likely had a concussion, and then discharge them. “Patients are not often happy with that,” Christensen says. “They want something concrete to tell them they do or don’t have a concussion.”
Currently, the device holds FDA approval for 13 to 85 year olds. BrainScope is working toward its acceptance for use in any age, but there has not been a large enough sample size of those age extremes in the clinical trials to qualify yet.
Christensen is also excited at the potential for the device to be used in diagnosing strokes. EMTs being able to accurately identify a stroke at the scene means saving precious time by taking the person right to a stroke center for treatment. “Your own brain wave is all that’s read for that to happen,” Christensen says. “So simple, and yet what it does is so significant.”