Gesa Cohrs1, Monika Huhndorf2, Nils Niemczyk1, Lukas J Volz3, Alexander Bernsmeier4, Ash Singhal5, Naomi Larsen2, Michael Synowitz1, Friederike Knerlich-Lukoschus6,7. 1. Department of Neurosurgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, House 41, 24105, Kiel, Germany. 2. Department of Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, House 41, 24105, Kiel, Germany. 3. Department of Neurology, University Hospital Cologne, Cologne, Germany. 4. Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, House 41, 24105, Kiel, Germany. 5. Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada. 6. Department of Neurosurgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, House 41, 24105, Kiel, Germany. f.knerlich@asklepios.com. 7. Asklepios Klinik Sankt Augustin, Department of Pediatric Neurosurgery, Arnold-Janssen-Str.29, 53757, Sankt Augustin, Germany. f.knerlich@asklepios.com.
Abstract
PURPOSE: Magnetic resonance imaging (MRI) is a sensitive imaging tool which lacks the burden of ionizing radiation. It is not established as primary diagnostic tool in traumatic brain injury (TBI). The purpose of this study was to evaluate the usefulness of MRI as initial imaging modality in the emergency management of mild pediatric TBI. METHODS: Children (0-18 years, sub-divided in four age-groups) with mild TBI who received MRI in the emergency department were identified. Clinical characteristics and trauma mechanisms were evaluated retrospectively. Univariate and multivariate logistic regression analyses were used to identify clinical factors that might be indicative for trauma sequelae on MRI scans. RESULTS: An institutional case series of 569 patients (322 male/247 female; age < 18years; (GCS ≥ 13), who received MRI for mild TBI, was analyzed. Multi-sequence imaging (including T2, T2*, FLAIR, and diffusion-weighted sequences) was feasible without sedation in 96.8% of cases (sedation, 1.8%; general anesthesia, 1.4%). MRI revealed trauma-associated findings in 13% of all cases; incidental findings were detected in 4.7%. In our cohort, GCS deterioration, scalp hematoma, clinical signs of skull base fractures, and horseback riding accidents were related to structural trauma sequelae on MRI. CONCLUSIONS: MRI is a practical primary imaging tool for evaluating children with mild TBI in the emergency department. The presented analyses demonstrated that in our institution, MRI imaging is performed frequently in the emergency department. It resulted mostly in normal findings. This may reflect uneasiness of when to perform imaging in mild TBI and appears retrospectively as an "overdo." There are clinical factors that are more likely associated with MRI-positive findings. Their reliability has to be evaluated in prospective studies in order to formulate further decision rules of when to perform MRI imaging or not.
PURPOSE: Magnetic resonance imaging (MRI) is a sensitive imaging tool which lacks the burden of ionizing radiation. It is not established as primary diagnostic tool in traumatic brain injury (TBI). The purpose of this study was to evaluate the usefulness of MRI as initial imaging modality in the emergency management of mild pediatric TBI. METHODS:Children (0-18 years, sub-divided in four age-groups) with mild TBI who received MRI in the emergency department were identified. Clinical characteristics and trauma mechanisms were evaluated retrospectively. Univariate and multivariate logistic regression analyses were used to identify clinical factors that might be indicative for trauma sequelae on MRI scans. RESULTS: An institutional case series of 569 patients (322 male/247 female; age < 18years; (GCS ≥ 13), who received MRI for mild TBI, was analyzed. Multi-sequence imaging (including T2, T2*, FLAIR, and diffusion-weighted sequences) was feasible without sedation in 96.8% of cases (sedation, 1.8%; general anesthesia, 1.4%). MRI revealed trauma-associated findings in 13% of all cases; incidental findings were detected in 4.7%. In our cohort, GCS deterioration, scalp hematoma, clinical signs of skull base fractures, and horseback riding accidents were related to structural trauma sequelae on MRI. CONCLUSIONS: MRI is a practical primary imaging tool for evaluating children with mild TBI in the emergency department. The presented analyses demonstrated that in our institution, MRI imaging is performed frequently in the emergency department. It resulted mostly in normal findings. This may reflect uneasiness of when to perform imaging in mild TBI and appears retrospectively as an "overdo." There are clinical factors that are more likely associated with MRI-positive findings. Their reliability has to be evaluated in prospective studies in order to formulate further decision rules of when to perform MRI imaging or not.
Entities:
Keywords:
Alternative imaging; Children; Head injury; Imaging
Authors: Sandra D W Buttram; Pamela Garcia-Filion; Jeffrey Miller; Mostafa Youssfi; S Danielle Brown; Heidi J Dalton; P David Adelson Journal: Hosp Pediatr Date: 2015-02
Authors: P E Vos; Y Alekseenko; L Battistin; E Ehler; F Gerstenbrand; D F Muresanu; A Potapov; C A Stepan; P Traubner; L Vecsei; K von Wild Journal: Eur J Neurol Date: 2012-02 Impact factor: 6.089
Authors: David C Sheridan; Craig D Newgard; Nathan R Selden; Mubeen A Jafri; Matthew L Hansen Journal: J Neurosurg Pediatr Date: 2016-11-25 Impact factor: 2.375
Authors: Diana L Miglioretti; Eric Johnson; Andrew Williams; Robert T Greenlee; Sheila Weinmann; Leif I Solberg; Heather Spencer Feigelson; Douglas Roblin; Michael J Flynn; Nicholas Vanneman; Rebecca Smith-Bindman Journal: JAMA Pediatr Date: 2013-08-01 Impact factor: 16.193
Authors: D Clay Samples; Michael T Bounajem; David J Wallace; Lillian Liao; Izabela Tarasiewicz Journal: Childs Nerv Syst Date: 2019-06-08 Impact factor: 1.475