Optimizing mild traumatic brain injury (mTBI) triage: A comparative analysis of CEREBO® vs clinical prediction in reducing CT utilization and improving cost-effectiveness.

OBJECTIVE: Clinical Prediction Rules (CPR) such as the New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), and Canadian Computed Tomography Head Rules (CCHR) are standard triaging guidelines to determine the need for CT in mTBI. This study evaluates the effectiveness of CEREBO®, a machine learning-powered near infrared spectroscopy (NIRS) device, in triaging mTBI patients as compared to CPR. METHODS: 376 patients with mTBI from 3 single-center studies at NIMHANS Bengaluru, Civil Hospital, Ahmedabad and AIIMS, Bhopal underwent secondary analysis. The patients underwent CEREBO® scanning, and results were compared to CT using the Diagnostic Efficiency and Reduction of CT scans (D-ERCS) Framework. Data from published literature was used to compare with CPR. The diagnostic accuracy of CEREBO®, reduction in unnecessary CT scans and number-needed-to-scan (NNS) in comparison to CPR were calculated. RESULTS: CEREBO® demonstrated superior diagnostic accuracy - 96.6% sensitivity, 84.2% specificity, reducing unnecessary CT scans by 67.4-85.7% in pediatric, 63-83.8% in adult, and 20.3-65.7% in geriatric populations. CEREBO® achieved an NNS of 3-4 as compared to 9-13 scans with CPR, demonstrating efficiency in identifying positive cases. The usage of CEREBO® was 94%, 95.6% and 95.2% cheaper as compared to the NOC, CCHR and NICE guidelines respectively. CONCLUSION: CEREBO® is a reliable tool for triaging mTBI, offering accurate diagnoses while significantly reducing unnecessary imaging. By lowering radiation exposure. optimizing resource use, being cost-effective and more efficient, it provides a safer triaging approach, particularly beneficial in resource-limited settings.