El Pasoans now have access to a cutting-edge biomedical device with the potential to improve the assessment of brain injuries. The technology, called BrainScope One, promises to help patients with mild traumatic brain injuries by ruling out brain bleeding without the need for a pricey CT scan.
“We have the chance to be early users of a medical device that has just hit the U.S. market — that opportunity doesn’t come along often,” said Edward A. Michelson, M.D., professor and chair of the Department of Emergency Medicine at Texas Tech University Health Sciences Center El Paso (TTUHSC El Paso) and medical director of the emergency department at University Medical Center of El Paso (UMC).
UMC is the first Texas hospital and second emergency department in the nation to make BrainScope One technology available to patients. As an affiliate hospital of TTUHSC El Paso, that means our university’s emergency medicine residents can now order BrainScope One tests for their patients. This gives residents valuable training on how to weigh evidence to make informed decisions about patient care, said Dr. Michelson.
If a patient walks in with a head injury and symptoms of a concussion, a quick readout from the device can identify the likelihood of bleeding in the brain—an oftentimes life-threatening condition that can cause loss of brain function. The faster treatment is implemented, the less likely it is that a patient dies or experiences complications like loss of memory, speech or movement.
Normally, a head CT scan is required to rule out visible brain injuries, including bleeding. The problem is that the scans are not only time-consuming and expensive, but involve radiation to the body. One CT scan delivers the equivalent radiation of 200 chest X-rays. And depending on where you live, the scan can cost anywhere from $825 to $4,800.
BrainScope One, on the other hand, emits no radiation and can be used at the patient’s bedside in the emergency department. In addition, Dr. Michelson estimates the test will cost no more than $250 to $300 per patient.
The device is simple to use. A disposable electrode headset is attached to a patient’s forehead to measure electrical activity in the brain and detect if anything is amiss. The headset is connected to a smartphone-like hand-held device equipped with BrainScope One’s proprietary software.
“After you hit your head, if you’re having symptoms, the electrical waves in your brain will be flowing differently; your neurons will have been shaken up,” Dr. Michelson explained. “BrainScope One has a huge database showing what normal brain waves look like using data collected from thousands of individuals of all ages and genders.”
Using a special algorithm, the device compares the patient’s brain electrical activity to that of age-matched, uninjured people. If the patient’s BrainScope One results indicate variance from normal, the doctor will order a CT scan to pinpoint the location and extent of the bleeding so neurosurgeons can make treatment decisions. If the patient’s BrainScope One scan doesn’t indicate variance from normal, the doctor may opt not to do a CT scan, saving the patient time, money and unnecessary radiation.
Currently, most emergency medicine physicians use either intuition—backed by years of experience in diagnosing head trauma—or “clinical decision rules” to determine whether a CT scan is necessary. Clinical decision rules are ways to standardize and objectively interpret clinical data from the patient’s history, examination and simple tests.
For example, the Canadian Head CT Rule, regarded as the gold standard of clinical decision rules, considers variables like whether the patient experienced a seizure prior to coming to the ER, if they show a focal neurological deficit, or if they have an obvious skull fracture. These rules work much like BrainScope One; they guide doctors on the decision to order a CT scan.
Because it’s important to catch brain bleeding early, BrainScope One and clinical decision rules are designed to flag any and all variances from a normal brain. In other words, it doesn’t take much for a patient’s brain to be flagged for potential bleeding.
“These tests can give you a lot of false positives because they lean more toward sensitivity than specificity,” said Nick Reiter, M.D., first-year emergency medicine resident at TTUHSC El Paso. But, as Dr. Reiter explains, emergency medicine physicians have to be very cautious about ruling out brain injuries because every patient presents differently; one patient with intracranial bleeding might look entirely different from another patient suffering from the same condition.
While BrainScope One is no replacement for a traditional CT scan, it has the potential to benefit patients who are very low risk for brain bleeding.
Eric Johansen, M.S.N., M.B.A., R.N., is excited to have the new technology at UMC.
“Our quality of care is going to improve,” said Johansen, who oversees the hospital’s emergency department. “With the high correlation the device has for brain injury or bleeding, this will assist in expediting those who do need the CT of the head to the top of the list.”
He added, “This is going to ensure that the only Level 1 trauma center in the region is using cutting-edge technology.”
BrainScope One, which came on the market in 2017, is currently approved for use in patients 18 to 85 years of age within three days of injury. Dr. Michelson hopes in the near future that the device will also cover patients ages 12 to 18.
He said, “We look forward to getting clearance for use of the in the adolescent population, given the number of sports-related head injuries that take place in middle and high-school students.”
About Dr. Michelson
Dr. Michelson is credited with planting the seed for BrainScope One’s use in El Paso. For the past 10 years, he has served as a medical consultant and advisor for BrainScope Company Inc., the Maryland-based neuro-tech company that developed the tool. He has co-authored multiple studies on the device and its effectiveness.