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Toward A Better Care Pathway for Minor Head Injury



Ninety-five percent of head injured patients that visit the Emergency Department (ED) are “mild.” The current standard of care for 80% of these patients is to order a head CT to rule out an intracranial bleed. These patients are often last in line for CT resources increasing wait time and are often bumped by more serious cases. Furthermore, many of these scans will be negative for intracranial brain bleeds (91%).


Michelson and colleagues found that head injured patients that receive a CT scan can spend 6 or more hours in the ED. Much of this time is spent waiting – waiting to be assessed, waiting for transfer to CT, waiting for return transfer, waiting for results to be read, waiting for the ED physician to review the results and determine next steps.


Patient care, safety and satisfaction are profoundly impacted by unnecessary radiation (a head CT is the equivalent of approximately 20 chest X-rays), long wait times, high out-of-pocket costs, and an unmet need for an objective concussion assessment. For these reasons and others, the American College of Emergency Physicians (ACEP) partnered with Choosing Wisely® to provide a list of recommendations of how to avoid unnecessary procedures and associated costs. Avoidance of head CTs in low-risk patients is the number one recommendation.


BrainScope offers EDs an innovative option to help improve department flow and patient experience. The head injury care pathway has not changed in decades, and the same workup for all patients is used despite their presenting condition. The BrainScope device can be used on alert patients presenting to the ED within a 72-hour window post-injury, a period within which most patients seek care.


A point of care decision support tool, BrainScope can help rule out the need for a head CT within 15-20 minutes. The assessment can be run by a nurse, a technician, or another identified clinical/nonclinical member of the staff. The results do not require specialized physician interpretation. Less waiting for the test, less waiting for results means less time spent in the ED, and therefore a better patient experience.


A BrainScope assessment also answers the real question many patients come to the ED for “Do I have a concussion?” Unknown to many, a head CT cannot detect concussion—concussed patients are often sent home from the ED without the information they need to start appropriate care. Moreover, the results of concussion tests that do exist are highly subjective and can lead to misclassification up to half of the time. The lack of a standardized concussion assessment protocol or referral pathway can have both short and long-term consequences as early evaluation and intervention is paramount to the care of head injured patients and can lead to shorter recovery time.


BrainScope’s breakthrough technology combines AI and machine learning to derive proprietary, well validated algorithms to provide objective, actionable results on the likelihood of a brain bleed and brain function impairment. To date, BrainScope is the only FDA cleared medical device to offer an assessment of both structural and functional head injuries. Both assessments are completed and reported simultaneously.


Adopting a handheld point of care decision support tool to rapidly triage head injured patients for the likelihood of intracranial hemorrhage and concussion is an important starting point in improving the current state of head injury diagnosis and care.


Learn more about BrainScope, www.brainscope.com.


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