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|Issue 138||November 2017|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Brief: Near Infrared Spectroscopy for Detecting Brain Hematoma
Falls are a common cause of orthopedic and head injuries among elderly populations, particularly those residing in nursing homes. Most patients with moderate-severe injuries after falls are transported to an emergency department (ED) or trauma center, but clinicians may struggle with management decisions for patients with mild injuries, particularly when the circumstances of the fall are unknown and patients cannot provide additional history or participate in the physical exam due to pre-existing dementia or other cognitive disorders. Mild head injury management guidelines commonly recommend head computed tomography (CT) for all patients ≥ 65 years old. However, most patients with mild head injuries who undergo head CT have normal findings, raising concern about the overuse of head CT and implications for patient safety due to radiation exposure.
Near infrared spectroscopy (NIRS) is an imaging technique used to identify intracranial hematomas by detecting asymmetry in light absorption over the right and left sides of the head without the use of radiation. Handheld NIRS devices offer a portable, non-invasive, and quick means of evaluating patients with mild head injury for the presence of a brain hematoma – and could potentially aid in clinical decision-making to avoid unnecessary CTs.
This evidence brief sought to evaluate the potential impact of NIRS use among nursing home patients after falls by describing the technical feasibility of NIRS for detecting brain hematomas and synthesizing the evidence on the performance characteristics of NIRS, as well as its impact on diagnostic and therapeutic decision-making, patient outcomes, potential harms, and cost-effectiveness. Investigators with VA's Evidence-based Synthesis Coordinating Center in Portland, OR reviewed the literature including: MEDLINE®, Cochrane Database of Systematic reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Health Technology Assessment, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, CINAHL, Military & Government Collection, and Scopus up to 6/30/2017. After reviewing 797 articles, 13 (12 observational studies and 1 systematic review) were used for this evidence brief.
Summary of Review
Potential harms of NIRS as a test for hematomas in nursing home patients after falls are primarily related to the possibility of obtaining a negative NIRS scan in a patient who truly has a hematoma in need of further intervention. In addition, there could be unintended consequences of transporting fewer patients to EDs after falls, including strain on nursing home staff due to more frequent monitoring of patients as well as missed opportunities to identify reasons for patient falls if they do not undergo more extensive testing.
To avoid some of the methodologic limitations of existing studies of NIRS, future studies should:
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.
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