Comparison of quantitative electroencephalogram to current clinical decision rules for head computed tomography use in acute mild traumatic brain injury in the ED

abstract Article history:Received 16 October 2014Accepted 7 November 2014Available online xxxx Studyobjective: Wecomparedtheperformanceofa handheldquantitativeelectroencephalogram(QEEG) acqui-sition device to New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR), and National Emergency X-RadiographyUtilizationStudyII(NEXUSII)Ruleinpredictingintracraniallesionsonheadcomputedtomography(CT) in acute mild traumatic brain injury in the emergency department (ED).Methods: Patients between 18 and 80 years of age who presented to the ED with acute blunt head trauma wereenrolled in this prospective observational study at 2 urban academic EDs in Detroit, MI. Data were collected for10minutesfrom frontal leads to determinea QEEGdiscriminantscore that couldmaximally classify intracraniallesions on head CT.Results: One hundred fifty-two patients were enrolled from July 2012 to February 2013. A total 17.1% had acutetraumatic intracranial lesionsonheadCT.Quantitative electroencephalogramdiscriminant scoreofgreaterthanorequalto31wasfoundtobeagoodcutoff(areaunderreceiveroperatingcharacteristiccurve=0.84;95%con-fidence interval [CI], 0.76-0.93) to classify patients with positive head CT. The sensitivity of QEEG discriminantscorewas92.3(95%CI,73.4-98.6),whereasthespecificitywas57.1(95%CI,48.0-65.8).Thesensitivityandspec-ificityofthedecisionruleswereasfollows:NOC96.1(95%CI,78.4-99.7)and15.8(95%CI,10.1-23.6);CCHR46.1(95% CI, 27.1-66.2) and 86.5 (95% CI, 78.9-91.7); NEXUS II 96.1 (95% CI, 78.4-99.7) and 31.7 (95% CI, 23.9-40.7).Conclusion: At a sensitivity of greater than 90%, QEEG discriminant score had better specificity than NOC andNEXUSII.OnlyCCHRhadbetterspecificitythanQEEGdiscriminantscorebutatthecostoflow(b50%)sensitivity.© 2014 Elsevier Inc. All rights reserved.