Prehospital Electroencephalography to Detect Traumatic Brain Injury during Helicopter Transport: A Pilot Observational Cohort Study.
Prehospital Electroencephalography to Detect Traumatic Brain Injury during Helicopter Transport: A Pilot Observational Cohort Study.
复制标题
院前脑电图检测直升机运输期间的创伤性脑损伤：一项试点观察队列研究。
DOI：
10.1080/10903127.2023.2185333
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发表时间：
2024
影响因子：
2.4
通讯作者：
Elmer,Jonathan
中科院分区：
文献类型：
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作者：
Barton,DavidJ;Coppler,PatrickJ;Talia,NadineN;Charalambides,Alexi;Stancil,Brian;Puccio,AvaM;Okonkwo,DavidO;Callaway,CliftonW;Guyette,FrancisX;Elmer,Jonathan
目的早期认识创伤性脑损伤(TBI)对及时救治具有重要意义。脑电图(EEG)可以识别脑外伤，但EEG的可行性还没有在院前环境中进行评估。我们测试了在创伤后空中医疗运输过程中获取单通道脑电的可行性。我们测量了定量脑电特征、早期血液生物标志物和头部计算机断层扫描(CT)异常之间的关系。方法我们进行了一项先导性前瞻性观察性研究，纳入了由重症监护飞机救护车从创伤现场运送到I级创伤中心的连续患者。在运送过程中，院前临床医生在患者的额头上放置了传感器，以记录脑电。我们回顾了脑电波形，并选择了90 秒的记录进行定量分析。脑电数据处理包括快速傅立叶变换，以总结增量(0-4 赫兹)、θ(4-8 赫兹)和阿尔法(8-13 赫兹)范围内的分量频率功率。分别于伤后第1天和第3天采血，测定两种脑损伤标志物(泛素C末端水解酶L1[UCH-L1]和胶质纤维酸性蛋白[GFAP])的水平。我们比较了有和没有CT阳性脑损伤发现的个体之间的预测因素。结果纳入40名受试者，其中34人(85%)成功获得脑电记录。失败的原因包括电池未充电(n= 5)和用户错误(n= 1)。在三起案件中，数据丢失。在31例有数据的受试者中，26例(84%)记录到了可解释的脑电信号。平均年龄为48岁(SD 16)，其中79%为男性，50%经历过机动车撞车事故。8名受试者(24%)有CT阳性的脑损伤。患有和不患有CT阳性脑损伤的受试者具有相似的中位增量功率、α功率和θ功率。UCH-L1和GFAP血浆水平在不同组之间没有差异。Delta功率与Uch-L1 d1血浆浓度呈负相关(r=-0.6 0，p = 0.0 3)。结论创伤后空运过程中院前脑电采集是可行的。
ObjectiveEarly recognition of traumatic brain injury (TBI) is important to facilitate time-sensitive care. Electroencephalography (EEG) can identify TBI, but feasibility of EEG has not been evaluated in prehospital settings. We tested the feasibility of obtaining single-channel EEG during air medical transport after trauma. We measured association between quantitative EEG features, early blood biomarkers, and abnormalities on head computerized tomography (CT).MethodsWe performed a pilot prospective, observational study enrolling consecutive patients transported by critical care air ambulance from the scene of trauma to a Level I trauma center. During transport, prehospital clinicians placed a sensor on the patient’s forehead to record EEG. We reviewed EEG waveforms and selected 90 seconds of recording for quantitative analysis. EEG data processing included fast Fourier transform to summarize component frequency power in the delta (0-4 Hz), theta (4-8 Hz), and alpha (8-13 Hz) ranges. We collected blood samples on day 1 and day 3 post-injury and measured plasma levels of two brain injury biomarkers (ubiquitin C-terminal hydrolase L1 [UCH-L1] and glial fibrillary acidic protein [GFAP]). We compared predictors between individuals with and without CT-positive TBI findings.ResultsForty subjects were enrolled, with EEG recordings successfully obtained in 34 (85%). Reasons for failure included uncharged battery (n= 5) and user error (n= 1). Data were lost in three cases. Of 31 subjects with data, interpretable EEG signal was recorded in 26 (84%). Mean age was 48 (SD 16) years, 79% were male, and 50% suffered motor vehicle crashes. Eight subjects (24%) had CT-positive TBI. Subjects with and without CT-positive TBI had similar median delta power, alpha power, and theta power. UCH-L1 and GFAP plasma levels did not differ across groups. Delta power inversely correlated with UCH-L1 day 1 plasma concentration (r = -0.60, p = 0.03).ConclusionsPrehospital EEG acquisition is feasible during air transport after trauma.