Bilateral near-infrared spectroscopy for detecting traumatic vascular injury

Robert M. Van Haren, Mark L. Ryan, Chad M. Thorson, Nicholas Namias, Alan Livingstone, Kenneth G Proctor

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Extremity wounds account for most battlefield injuries. Clinical examination may be unreliable by medics or first responders, and continuous assessment by experienced practitioners may not be possible on the frontline or during transport. Near-infrared spectroscopy (NIRS) provides continuous, noninvasive monitoring of tissue oxygen saturation (StO 2), but its use is limited by inter-patient and intra-patient variability. We tested the hypothesis that bilateral NIRS partially addresses the variability problem and can reliably identify vascular injury after extremity trauma. Materials and methods: This prospective study consisted of 30 subjects: 20 trauma patients with extremity injury and 10 healthy volunteers. Bilateral StO2 tissue sensors were placed on the thenar eminence or medial plantar surface. Injured and non-injured extremities within the same patient (ΔStO2) were compared using Wilcoxon signed ranks test. Receiver operating characteristic curves were generated and areas under the curve (AUCs) were calculated for ΔStO2 of 6, 10, and 15. Values are expressed as median (interquartile range). Results: Trauma patients were age 31 y (23 y), 85% male, with injury severity score of 9 (5). There were seven arterial and three venous injuries. Most involved the lower extremity (n = 16; 80%) and resulted from a penetrating mechanism (n = 14; 70%). ΔStO 2 between limbs was 20.4 (10.4) versus 2.4 (3.0) (P < 0.001) for all patients with vascular injury versus patients and volunteers with no vascular injury. ΔStO2 reliably identified any vascular injury (AUC, 0.975; P < 0.001), whereas pulse examination alone or in combination with Doppler exam could detect only arterial injury. A ΔStO2 of 6 had the greatest sensitivity and specificity (AUC, 0.900; P < 0.001). Conclusions: Continuous monitoring of bilateral limbs with NIRS detects changes in perfusion resulting from arterial or venous injury and may offer advantages over serial manual measurements of pulses or Doppler signals. This technique may be most relevant in military and disaster scenarios or during transport, in which the ability to monitor limb perfusion is difficult or experienced clinical judgment is unavailable.

Original languageEnglish
Pages (from-to)526-532
Number of pages7
JournalJournal of Surgical Research
Volume184
Issue number1
DOIs
StatePublished - May 10 2013

Fingerprint

Near-Infrared Spectroscopy
Vascular System Injuries
Extremities
Wounds and Injuries
Area Under Curve
Perfusion
Median Eminence
Injury Severity Score
Aptitude
Disasters
Nonparametric Statistics
ROC Curve
Volunteers
Lower Extremity
Healthy Volunteers
Prospective Studies
Oxygen
Sensitivity and Specificity

Keywords

  • Battlefield
  • Near-infrared spectroscopy
  • Trauma
  • Vascular injury

ASJC Scopus subject areas

  • Surgery

Cite this

Bilateral near-infrared spectroscopy for detecting traumatic vascular injury. / Van Haren, Robert M.; Ryan, Mark L.; Thorson, Chad M.; Namias, Nicholas; Livingstone, Alan; Proctor, Kenneth G.

In: Journal of Surgical Research, Vol. 184, No. 1, 10.05.2013, p. 526-532.

Research output: Contribution to journalArticle

@article{0816a91660a245d4abbf50caffbf51d5,
title = "Bilateral near-infrared spectroscopy for detecting traumatic vascular injury",
abstract = "Background: Extremity wounds account for most battlefield injuries. Clinical examination may be unreliable by medics or first responders, and continuous assessment by experienced practitioners may not be possible on the frontline or during transport. Near-infrared spectroscopy (NIRS) provides continuous, noninvasive monitoring of tissue oxygen saturation (StO 2), but its use is limited by inter-patient and intra-patient variability. We tested the hypothesis that bilateral NIRS partially addresses the variability problem and can reliably identify vascular injury after extremity trauma. Materials and methods: This prospective study consisted of 30 subjects: 20 trauma patients with extremity injury and 10 healthy volunteers. Bilateral StO2 tissue sensors were placed on the thenar eminence or medial plantar surface. Injured and non-injured extremities within the same patient (ΔStO2) were compared using Wilcoxon signed ranks test. Receiver operating characteristic curves were generated and areas under the curve (AUCs) were calculated for ΔStO2 of 6, 10, and 15. Values are expressed as median (interquartile range). Results: Trauma patients were age 31 y (23 y), 85{\%} male, with injury severity score of 9 (5). There were seven arterial and three venous injuries. Most involved the lower extremity (n = 16; 80{\%}) and resulted from a penetrating mechanism (n = 14; 70{\%}). ΔStO 2 between limbs was 20.4 (10.4) versus 2.4 (3.0) (P < 0.001) for all patients with vascular injury versus patients and volunteers with no vascular injury. ΔStO2 reliably identified any vascular injury (AUC, 0.975; P < 0.001), whereas pulse examination alone or in combination with Doppler exam could detect only arterial injury. A ΔStO2 of 6 had the greatest sensitivity and specificity (AUC, 0.900; P < 0.001). Conclusions: Continuous monitoring of bilateral limbs with NIRS detects changes in perfusion resulting from arterial or venous injury and may offer advantages over serial manual measurements of pulses or Doppler signals. This technique may be most relevant in military and disaster scenarios or during transport, in which the ability to monitor limb perfusion is difficult or experienced clinical judgment is unavailable.",
keywords = "Battlefield, Near-infrared spectroscopy, Trauma, Vascular injury",
author = "{Van Haren}, {Robert M.} and Ryan, {Mark L.} and Thorson, {Chad M.} and Nicholas Namias and Alan Livingstone and Proctor, {Kenneth G}",
year = "2013",
month = "5",
day = "10",
doi = "10.1016/j.jss.2013.03.090",
language = "English",
volume = "184",
pages = "526--532",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "1",

}

TY - JOUR

T1 - Bilateral near-infrared spectroscopy for detecting traumatic vascular injury

AU - Van Haren, Robert M.

AU - Ryan, Mark L.

AU - Thorson, Chad M.

AU - Namias, Nicholas

AU - Livingstone, Alan

AU - Proctor, Kenneth G

PY - 2013/5/10

Y1 - 2013/5/10

N2 - Background: Extremity wounds account for most battlefield injuries. Clinical examination may be unreliable by medics or first responders, and continuous assessment by experienced practitioners may not be possible on the frontline or during transport. Near-infrared spectroscopy (NIRS) provides continuous, noninvasive monitoring of tissue oxygen saturation (StO 2), but its use is limited by inter-patient and intra-patient variability. We tested the hypothesis that bilateral NIRS partially addresses the variability problem and can reliably identify vascular injury after extremity trauma. Materials and methods: This prospective study consisted of 30 subjects: 20 trauma patients with extremity injury and 10 healthy volunteers. Bilateral StO2 tissue sensors were placed on the thenar eminence or medial plantar surface. Injured and non-injured extremities within the same patient (ΔStO2) were compared using Wilcoxon signed ranks test. Receiver operating characteristic curves were generated and areas under the curve (AUCs) were calculated for ΔStO2 of 6, 10, and 15. Values are expressed as median (interquartile range). Results: Trauma patients were age 31 y (23 y), 85% male, with injury severity score of 9 (5). There were seven arterial and three venous injuries. Most involved the lower extremity (n = 16; 80%) and resulted from a penetrating mechanism (n = 14; 70%). ΔStO 2 between limbs was 20.4 (10.4) versus 2.4 (3.0) (P < 0.001) for all patients with vascular injury versus patients and volunteers with no vascular injury. ΔStO2 reliably identified any vascular injury (AUC, 0.975; P < 0.001), whereas pulse examination alone or in combination with Doppler exam could detect only arterial injury. A ΔStO2 of 6 had the greatest sensitivity and specificity (AUC, 0.900; P < 0.001). Conclusions: Continuous monitoring of bilateral limbs with NIRS detects changes in perfusion resulting from arterial or venous injury and may offer advantages over serial manual measurements of pulses or Doppler signals. This technique may be most relevant in military and disaster scenarios or during transport, in which the ability to monitor limb perfusion is difficult or experienced clinical judgment is unavailable.

AB - Background: Extremity wounds account for most battlefield injuries. Clinical examination may be unreliable by medics or first responders, and continuous assessment by experienced practitioners may not be possible on the frontline or during transport. Near-infrared spectroscopy (NIRS) provides continuous, noninvasive monitoring of tissue oxygen saturation (StO 2), but its use is limited by inter-patient and intra-patient variability. We tested the hypothesis that bilateral NIRS partially addresses the variability problem and can reliably identify vascular injury after extremity trauma. Materials and methods: This prospective study consisted of 30 subjects: 20 trauma patients with extremity injury and 10 healthy volunteers. Bilateral StO2 tissue sensors were placed on the thenar eminence or medial plantar surface. Injured and non-injured extremities within the same patient (ΔStO2) were compared using Wilcoxon signed ranks test. Receiver operating characteristic curves were generated and areas under the curve (AUCs) were calculated for ΔStO2 of 6, 10, and 15. Values are expressed as median (interquartile range). Results: Trauma patients were age 31 y (23 y), 85% male, with injury severity score of 9 (5). There were seven arterial and three venous injuries. Most involved the lower extremity (n = 16; 80%) and resulted from a penetrating mechanism (n = 14; 70%). ΔStO 2 between limbs was 20.4 (10.4) versus 2.4 (3.0) (P < 0.001) for all patients with vascular injury versus patients and volunteers with no vascular injury. ΔStO2 reliably identified any vascular injury (AUC, 0.975; P < 0.001), whereas pulse examination alone or in combination with Doppler exam could detect only arterial injury. A ΔStO2 of 6 had the greatest sensitivity and specificity (AUC, 0.900; P < 0.001). Conclusions: Continuous monitoring of bilateral limbs with NIRS detects changes in perfusion resulting from arterial or venous injury and may offer advantages over serial manual measurements of pulses or Doppler signals. This technique may be most relevant in military and disaster scenarios or during transport, in which the ability to monitor limb perfusion is difficult or experienced clinical judgment is unavailable.

KW - Battlefield

KW - Near-infrared spectroscopy

KW - Trauma

KW - Vascular injury

UR - http://www.scopus.com/inward/record.url?scp=84884671250&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884671250&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2013.03.090

DO - 10.1016/j.jss.2013.03.090

M3 - Article

C2 - 23664592

AN - SCOPUS:84884671250

VL - 184

SP - 526

EP - 532

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 1

ER -