Diagnostic Performance of the Infrascanner 2000™ for Detecting Intracranial Hemorrhage in Traumatic Brain Injury Patients in Pakistan

BACKGROUND AND OBJECTIVES: Intracranial hemorrhage (ICH) is a major cause of morbidity and mortality after traumatic brain injury (TBI). Computed tomography (CT) is often unavailable in low-resource settings, delaying diagnosis. The Infrascanner 2000™, a handheld near-infrared device, has been proposed as a rapid, noninvasive ICH screening tool. The objective of this study was to determine the diagnostic accuracy of the Infrascanner 2000™ for detecting ICH in TBI patients, compared with noncontrast CT, at 2 tertiary care hospitals in Peshawar, Pakistan. METHODS: In this prospective observational study, 141 patients with mild, moderate, or severe TBI presenting to the emergency department of Neurosurgery at Northwest General Hospital and Lady Reading Hospital, Peshawar, Pakistan, underwent Infrascanner examination (inter-rater kappa 0.82), followed by noncontrast CT as the reference standard. Sensitivity, specificity, predictive values, likelihood ratios, balanced accuracy, and overall accuracy were calculated. Balanced accuracy (mean of sensitivity and specificity) replaced area under the curve, as the device yields a single binary operating point. Results followed Standard for Reporting Diagnostic Accuracy Studies guidelines. RESULTS: CT confirmed hemorrhage in 125 of 141 patients (88.6%). The Infrascanner showed sensitivity of 91.2%, specificity of 50.0%, positive predictive value of 93.4%, negative predictive value of 42.1%, and overall accuracy of 86.5% (positive likelihood ratio 1.82; negative likelihood ratio 0.18). Balanced accuracy was 0.706 (95% CI: 0.626-0.786), a single operating point rather than a conventional receiver operating characteristic–derived area under the curve. True positives were predominantly superficial hematomas; false negatives may reflect small or deep lesions. False positives could reflect extracranial soft-tissue injury, though this was not formally graded. CONCLUSION: The Infrascanner showed good sensitivity but modest specificity for ICH detection in this two-center Pakistani cohort, consistent with published series. It may serve as a rapid triage adjunct where CT access is delayed but should not replace CT imaging. Further multicenter studies, including prehospital settings, are warranted.