In emergency care, time is often the most critical variable, especially when it comes to traumatic brain injuries (TBIs). Yet in too many cases, patients with suspected brain injuries are subjected to the “wait and watch” approach: a cautious but risky decision to monitor symptoms rather than act.
This strategy, though often well-intentioned, can lead to devastating consequences when subdural hematomas (SDH) or epidural hematomas (EDH) are overlooked or progress silently during transport or delayed referral.
Today, as portable brain imaging tools like ArcheOptix’s NIRD® technology emerge, there’s a new opportunity to shorten the time between injury and diagnosis, potentially saving lives and preventing permanent damage. But to fully understand the need, let’s take a look at why delayed diagnosis is so dangerous in the first place.
When Mild Symptoms Mask Major Threats
It’s a common and misleading presentation: a patient who’s conscious, speaking clearly, and showing only mild symptoms after a fall or head trauma. They might report a headache, nausea, or brief disorientation. From the outside, everything seems relatively normal, no slurred speech, no signs of confusion, no visible injury. But these subtle symptoms can mask a deeper issue that’s quietly progressing beneath the surface.
Subdural hematomas can evolve gradually, especially in older adults, while epidural bleeds may present with a lucid interval, a period of apparent recovery, before rapid deterioration.
Some of the most commonly overlooked symptoms include:
- Mild or delayed-onset headache
- Slight confusion or forgetfulness
- Dizziness or balance issues attributed to age or dehydration
- Nausea or fatigue mistaken for stress or anxiety
- Lack of external trauma markers (e.g., no obvious swelling or lacerations)
These signs may be subtle, but the internal risk is not.
The Danger of Waiting for Symptoms to Evolve
The “wait and watch” approach often stems from limited resources, clinical uncertainty, or a belief that time will reveal whether a patient truly needs neurosurgical attention. But in brain injury, waiting can cost more than time.
Delayed diagnoses of intracranial bleeds are linked to:
- Increased intracranial pressure
- Seizures or herniation
- Decreased consciousness
- Long-term neurological deficits
- Increased mortality risk
This is especially concerning in cases involving elderly patients, those on anticoagulants, or those with unknown injury mechanisms. In these populations, even minor trauma can result in serious outcomes, and the deterioration may not occur until it’s too late to intervene effectively.
Rural Canada: Where Delays Can Stretch to 12 Hours or More
While the risks of delayed diagnosis are universal, the consequences are amplified in rural and remote regions, where access to advanced imaging like CT scans is severely limited.
In much of rural Canada:
- The nearest CT scanner may be hundreds of kilometers away
- Patient transport by ambulance or airlift can take 6 to 12 hours or longer
- Local clinicians may lack neuroimaging capabilities, relying solely on clinical observation
- Emergency referral pathways can be logistically complex and slow
In these scenarios, a “wait and watch” decision may be the default, not because of negligence, but because of lack of tools. The result? Patients may deteriorate en route, arrive at tertiary centers too late for intervention, or never be referred in the first place.
Why In-Field Detection Changes Everything
This is where point-of-care brain imaging like ArcheOptix’s NIRD® technology offers transformative potential.
NIRD® (Near-Infrared Diffuse Reflectance) technology enables non-invasive, radiation-free scanning of the brain for signs of subdural and epidural hematomas. It is:
- Portable: Easily used in ambulances, clinics, and rural health posts
- Fast: Provides results in minutes
- Accurate: Designed to detect clinically relevant bleeds with high sensitivity
- User-friendly: Operable by trained clinicians and paramedics in the field
Instead of guessing or waiting, providers can now screen patients on-site, making it possible to:
- Identify at-risk patients earlier
- Prioritize or escalate transport decisions
- Avoid unnecessary transfers
- Alert trauma centers in advance
- Initiate pre-hospital neuroprotection measures
This proactive approach compresses the diagnostic timeline, reducing the window between injury and surgical care, which is often the deciding factor in survival and recovery.
Case Example: When Early Detection Makes a Difference
Consider this scenario, based on real-world trends observed across rural health settings:
A 72-year-old woman slips on ice outside her home in a northern Ontario community. She hits the back of her head but doesn’t lose consciousness. A neighbour helps her up, and she insists she feels “just a little shaken.” An ambulance is called anyway.
On arrival, the paramedic notes that the patient is alert, responsive, and fully oriented showing no immediate signs of serious brain injury. She has a mild headache and some dizziness, but no vomiting, no confusion, and no visible injury. The closest CT scanner is over 5 hours away by road, with icy winter driving conditions.
The protocol is to monitor and consult with the nearest regional hospital. The physician on call recommends observation unless symptoms evolve.
Fortunately, the ambulance crew is equipped with a NIRD® device. They conduct a quick scan and detect an anomaly suggestive of subdural bleeding. With this information, the physician immediately escalates the case, arranging an urgent airlift to a neurosurgical center.
At the hospital, a CT scan confirms a subdural hematoma, and the patient undergoes successful intervention within 3 hours of the scan, far sooner than would have occurred without in-field detection.
This is the kind of clinical rescue that’s becoming more possible as detection moves closer to the point of injury.
Closing the Gaps in Brain Injury Triage
The evolution of tools like NIRD® marks a critical shift in how we approach head trauma. When we lack imaging capabilities in the field, we fall back on subjective symptoms and intuition, which can be misleading.
By bringing fast, accurate brain imaging to the front lines we arm providers with clarity, not just caution.
We Can’t Afford to Wait and Watch
In brain trauma, every minute matters. A lucid interval can create a false sense of stability, even when the risk is still present. A patient who appears alert and oriented may still be in danger. And in rural or resource-limited environments, the cost of delay grows with every mile.
The “wait and watch” trap is not just a clinical decision, it’s often a technological limitation. But with innovations like NIRD®, we now have the means to change that equation. Immediate, on-site detection empowers providers to take action sooner, refer more appropriately, and intervene before it’s too late.
About ArcheOptix
ArcheOptix is a Canadian medical device company dedicated to transforming the way Traumatic Brain Injuries are assessed, delivering CT-level accuracy for rural communities, emergency response teams, sports medicine, and more. Our focus on innovation and clinical excellence drives everything we do.
