Handheld Near-Infrared Device (InfrascannerTM) for Detection of Intracranial Haematoma in Children with Minor Head Injury

BACKGROUND: The use of head CT for the detection of possible intracranial haematoma in children with minor head injury (MHI) should be balanced against the risks related to radiation, as well as to sedation for uncooperative patients. Recently a handheld device using non-radiating near-infrared technology (InfrascannerTM) has shown good accuracy for detection of intracranial haematoma in adults with head injury. This device could be a useful tool to optimize the selection of children who will need to undergo a CT scan after a MHI. OBJECTIVE: This study aims to determine the feasibility of use and accuracy of InfrascannerTM in children with MHI. DESIGN/METHODS: Ongoing prospective observational study at the pediatric emergency departments in Padova and Treviso (Italy), including children at high or intermediate risk for intracranial injury according to the adapted PECARN rule in use. Completion of InfrascannerTM measurements (at 4 pre-selected pairs of locations on the head:frontal, temporal, parietal, and occipital regions) and time to completion are recorded. A positive result is defined by a difference in optical density of 0.2 between 2 symmetric regions. Decision on CT scan and CT scan reporting are performed independently and blinded to InfrascannerTM measurement results. RESULTS: 74 patients have been enrolled so far. Of these 37 (50%) were < 2 years of age. Completion of the InfrascannerTM measurement was successfully achieved without need of sedation in 72 (97%) patients, after a median of 4 minutes (interquartile range 2-6). A CT scan was performed in 12 (16%) children. A fracture was detected in 2 and no intracranial injuries were identified. InfrascannerTM measurements resulted positive in 5 (7%) patients. Of these 1 patient had a scalp haematoma overlying one of the measurement sites and 2 were infants. None of the patients who did not undergo a CT scan represented to the emergency department or had a CT scan performed at another site, as ascertained by telephone follow-up. CONCLUSIONS: InfrascannerTM seems an easy-to-use tool in the pediatric emergency department, thanks to the high completion rate and the short time to completion, with no need of sedation. Our preliminary data do not allow to assess its accuracy and its potential usefulness in guiding decision-making on CT scan. Further results are needed to evaluate its diagnostic accuracy.