An EEG device to replace the GCS. Thoughts?

[vicvicvictoria23]

Hello,

I currently work for a company developing a diagnostic, point-of-care device that is capable of assessing consciousness using EEG technology. The devices measures neural processing on five key factors: sensation, perception, attention, memory and language. It is a quick, 5 minute test that relies on involuntary brain activity. It is easy to use and administer. Like the GCS, the device produces a score that is out of 15. As the GCS is extremely subjective, this device would provide an objective score - it would also circumvent many limitations of the GCS. The device is called the Halifax Consciousness Scanner (HCS).

When considering potential markets, ambulances may benefit from this revolutionary device. I would like to know your thoughts and opinions. Would this be beneficial? Would this device be useful to you (EMTs/EMSs/first responders)?

For more information, visit our website: www.mindfulscientific.ca

Thanks so much,

Victoria

[croaker260]

Hello,

I currently work for a company developing a diagnostic, point-of-care device that is capable of assessing consciousness using EEG technology. The devices measures neural processing on five key factors: sensation, perception, attention, memory and language. It is a quick, 5 minute test that relies on involuntary brain activity. It is easy to use and administer. Like the GCS, the device produces a score that is out of 15. As the GCS is extremely subjective, this device would provide an objective score - it would also circumvent many limitations of the GCS. The device is called the Halifax Consciousness Scanner (HCS).

When considering potential markets, ambulances may benefit from this revolutionary device. I would like to know your thoughts and opinions. Would this be beneficial? Would this device be useful to you (EMTs/EMSs/first responders)?

For more information, visit our website: www.mindfulscientific.ca

Thanks so much,

Victoria

The things that come to mind:

1) Cost- As medicare reimburesments decrease, and every intervention is evaluated for cost effectivenenss, cost is an issue.

2) Ease of use - In crisis situations in severe TBI...EMS manpower is often limited. If this device requires the complete attention of one of the critical members of the team for afull five minutes when other immediate priorities exist, it probably wont get used much. On the other hand if you can attach it, press a button or three, then come back to it when you get a chance, it may be useful.

3) One area that I feel it woud be of huge use, depending on ease of use, and based on what little I saw on your website, is a secondary confirmation of mental status on patients refusing care, especially since it assesses memory, cognition, etc. If this could reduce litigation by providing a more thourough assessment of those patients who should be seen but are refusing (extreme sport athletes, patents who may have some intoxication but who appear cognitive, elderly who may have some intermittant dementia issues, or as mentioned the concussive football player...) then this is an excellent tool to reduce liablility to help document capacity to refuse care. In this role I see real promise.

That said, the above is simply speculation, and depends on the final product and the science/studies behind it, as well as cost.

Edited May 25, 2011 by croaker260

[ERDoc]

It sounds like an interesting device but I don't see it having much use in the world of emergency medicine. I would have to disagree that the GSC is that subjective. Yes, there is some subjectivity to it but not enough to where it would make a clinical difference. A one point difference between examiners is not going to change managment decisions significantly. A GCS can also be done in a lot less time than 5 minutes, time that you might not have when deciding to intubate. I think you would be better targeting this towards anesthesia/ICU type patients.

[fiznat]

^^ What the doc said.

In an emergency we don't really care whether the GCS is 8 versus 6. Both are bad. In the ICU setting, though, small changes in mental status might mean much more. I imagine they have a real EEG for that, though.....

[usalsfyre]

As noted above, I simply don't see EEG as having a lot of utility in emergency medicine, especially in out-of-hospital medicine.

[croaker260]

I still stand by my statement abvove, of course cost and ease of use being BIG factors.

[BEorP]

Hi Victoria,

Thanks for posting about this. It is definitely interesting research that you're involved in. I have a few questions/comments.

1. It will never replace GCS so i wouldn't try to market it like this

You are clearly working on something that could have a big impact on patient care. When I arrive at a car accident where there is another crew coming to back me up and they want to know the condition of the patients, I am quite likely to include a GCS to help them understand what we're dealing with. This is just one example of many where the HCS will not be practical and will not be replacing GCS.

2. Can it be used in a moving vehicle?

This will be a huge issue for EMS. If this is something that can only be done on scene and takes 5 minutes, it will not be nearly as useful. If it is an extra assessment I could do on the way to the hospital then sure, why not? (if someone wants to pay for it!) Five minutes may not be long for in hospital use, but with scene times for sick patients hopefully being less than 10 minutes, it isn't something we would have time to use. Sure, there are the odd case of someone who wants to refuse care and we could use it to assess them, but generally if we can't use it in the moving ambulance and it takes 5 minutes it isn't going to work for us for routine use in my opinion.

3. Is this really able to detect mTBI?

I was excited by the claims of detecting mTBI. This is where it could be hugely beneficial and could even be integrated into a return to play protocol for amateur or professional sports. mTBI is a huge issue that is just starting to get more attention so this is what really excited me about the HCS. I am curious as to how you have or will validate it for this use prior to marketing it.

I don't claim to know all of the science or understand any of it, but I tried to do a bit of searching on PubMed to see what there was to support the use of EEG to diagnose mTBI. The recent review that I found (http://www.ncbi.nlm.nih.gov/pubmed/16029958) mentioned:

"QEEG diagnostic discriminant testing reports and commercial marketing make claims that they can identify MTBI. The Thatcher mild head injury discriminant makes counterintuitive claims that the EEG changes are unaffected by drowsiness, sleep, or medications well known to affect EEG. That diagnostic discriminant failed to show good accuracy when evaluated by Thornton or in civilian injuries tested by Trudeau. Other diagnostic discriminants have been reported, but have not been prospectively verified. It is unknown what these various diagnostic discriminants will show when used on patients with other disorders on the differential diagnosis of cognitive or emotional problems. These claims still need impartial corroboration and prospective validation."

Obviously this is not my area of expertise, but from this article it seems like at least when it was written there was not much support for this. One thing we do not need in EMS are more fancy techy things that haven't been actually shown to do anything for our patients. Zoll has done well with the Autopulse, but please don't be Zoll.

Thanks again for posting this. It sure is an interesting area of research!