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New potential approach to traumatic brain injuries assessment, treatment

By Dr. Steven Galvan | U.S. Army Institute of Surgical Research Public Affairs | June 16, 2017


Researchers at the U.S. Army Institute of Surgical Research at Joint Base San Antonio-Fort Sam Houston, in collaboration with NeuroChaos, Inc., in Austin, Texas, are looking at a novel approach to assessing traumatic brain injuries which could assist in the way patients with TBI are identified, assessed and treated.

The research was designed to evaluate a new algorithm that measures cerebral blood flow velocity using transcranial Doppler technology called the Neurovascular Complexity Index, or NCI.

According to Jeffrey T. Howard, Ph.D., a general health scientist and epidemiologist at the USAISR and primary investigator, data was collected from about 170 healthy participants and compared to 12 patients with moderate and severe TBI.

“The objective of this research was to test the hypothesis that a measure of cerebral blood flow velocity variability would distinguish patients with moderate and severe TBI from healthy patients,” Howard said. 

Howard added that this type of research is relevant for the military since about 90 percent of combat casualties with TBI also suffer additional injuries, often including hemorrhage requiring resuscitation that can exacerbate brain injuries.

“What we’re hoping to do is to provide a tool that will help battlefield medics with the ability to diagnose TBI quickly, identify the severity of the TBI, and monitor the combat casualty continuously for prolonged periods of time,” Howard said.

A current approach for diagnosing a patient with a TBI is by using the Glasgow Coma Scale. Patients are assigned a numerical score according to three criteria: eye opening; best motor response; and best verbal response. A normal patient would be given a score of 15 using this scale. A patient with 13-14 score has mild TBI; 9-12 moderate TBI; and a score of 3-8 would be severe TBI. 

“One problem with the Glasgow Coma Scale is that it can be challenging to consistently perform due to differences in knowledge level and training of providers, combined with the complexity of individual variability of symptoms,” Howard said. “The advantage of the NCI is that it provides a quantitative, physiological measure of blood flow velocity to the brain and can detect disruptions in the normal patterns of blood flow variability that result from injuries.

“It is difficult to use the Glasgow Coma Scale to accurately diagnose and determine the severity of TBI at the point of injury or quickly thereafter, especially in austere environments with patients who have multiple injuries and may be unconscious due to a variety of factors.

“This new individualized approach is specific to the individual and is showing some encouraging results in distinguishing between healthy and injured patients with TBI,” Howard said. “We still have a while to go with this new approach, but it’s looking promising.”

The preliminary findings are being published in an upcoming issue of the Journal of Trauma and Acute Care Surgery.

Joint Base San Antonio-Fort Sam Houston Neurovascular Complexity Index U.S. Army Institute of Surgical Research