Emergency department implementation of abbreviated magnetic resonance imaging for pediatric traumatic brain injury

Lumba‐Brown, Angela; Lee, Moon O.; Brown, Ian; Cornwell, Jordan; Dannenberg, Bernard; Fang, Andrea; Ghazi‐Askar, Marjan; Grant, Gerald A.; Imler, Daniel; Khanna, Kajal; Lowe, Jason; Wang, Ewen; Wintermark, Max

doi:10.1002/emp2.12055

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…Cohen et al stated “Rapid protocols for head MRI after acute brain injury in pediatric patients have been shown to reduce examination times while maintaining a high level of accuracy. They require only 3–6 min inside the scanner and ultimately a minimal level of sedation in agitated children” [ 42 , 43 ]. Using MRI for diagnostics in children therefore seems to be increasing.…”

Section: Discussionmentioning

confidence: 99%

Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma

Ludwig

Heumann

Gümbel

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Severe accidents are the leading cause of long-term impairment and death in children. A common diagnostic procedure for children exposed to high-injury trauma is full-body contrast-enhanced CT (fbCT). However, the number of fbCT without detected injuries is relevant. In 2007, full-body MRI (fbMRI) was implemented as a diagnostic approach for children sustaining high-energy trauma. The aim of this cross-sectional retrospective study was to analyze fbMRI as a diagnostic tool for children after high-energy trauma focusing on feasibility, radiological findings, and limitations. Methods Diagnostics using fbMRI (from apex of the head to the pelvis) was performed if a child was stable and suffered a high-energy trauma in a Level I Trauma Center in Germany. 105 fbMRIs in patients exposed to high-energy trauma aged ≤ 16 years were performed between January 2007 and December 2018. Four fbMRIs were excluded as conducted for reasons other than trauma. Time between arrival in the emergency department and fbMRI, additional diagnostic procedures, injuries, and non-trauma related pathologies were analyzed. Results Mean time between arrival in the emergency department and fbMRI was 71 min (± SD 132 min). Two scans were discontinued and changed to a faster diagnostic procedure. 45% of children had additional X-rays and 11% CT scans. The MRIs showed intracranial abnormalities in 27%, extremities injuries in 26%, spinal injuries in 18%, pelvic, and thoracic injuries in 7% of the cases. Conclusion Overall fbMRI is a diagnostic alternative for hemodynamically stable, conscious children after high-energy trauma with the advantages of a radiation-free technique. However, MRI diagnostics take longer than CT scans. Prospective studies will be needed to identify the limiting factors of fbMRIs as primary diagnostic procedure compared to CT scans. Trial registration German Clinical Trials Register (DRKS; DRKS00017015). Level of evidence Case series, level of evidence V.

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Section: Discussionmentioning

confidence: 99%

Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma

Ludwig

Heumann

Gümbel

et al. 2021

Eur J Trauma Emerg Surg

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“…However, rapid MRI protocols have been developed to evaluate children with possible ventriculoperitoneal shunt malfunction, and these protocols are now being applied to children with traumatic brain injury. 12,13 Although evidence is currently limited on the use of rapid MRI protocols for both the initial evaluation of children with traumatic brain injury and for monitoring for hemorrhage progression in children with intracranial hemorrhage, [13][14][15][16] it is clear that many institutions are adopting MRI. Between 2010 and 2019, we found that the rates of repeat CT scans decreased by 9% and subsequent MRIs increased by 8%, whereas overall rates of repeat neuroimaging remained stable.…”

Section: Discussionmentioning

confidence: 99%

Trends and variation in repeat neuroimaging for children with traumatic intracranial hemorrhage

et al. 2021

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Objectives We aimed to determine trends and institutional variation in repeat neuroimaging in children with traumatic intracranial hemorrhage and to identify factors associated with neuroimaging modality (subsequent magnetic resonance imaging [MRI] vs computed tomography [CT]). Methods We conducted a retrospective cross‐sectional study of 35 hospitals in the Pediatric Health Information System database. We included children <18 years of age hospitalized from 2010–2019 with intracranial hemorrhage and who underwent a brain CT. We calculated repeat neuroimaging rates by modality and used regression analyses to examine temporal trends. We used hierarchical logistic regression to identify factors associated with subsequent MRI versus repeat CT, controlling for hospital. Results We identified 12,714 children with intracranial hemorrhage, of which 5072 with repeat neuroimaging were studied. Of the 5072 children with repeat neuroimaging, repeat CT was performed in 67.6% (n = 3429) and subsequent MRI in 32.4% (n = 1643). Overall repeat neuroimaging with either a CT or MRI remained similar from 2010–2019 ( P = 0.431); however, repeat CT scans significantly decreased ( P = 0.001); whereas, MRIs significantly increased ( P < 0.001). Repeat neuroimaging by hospital ranged from 20%–80%. After controlling for institution, subsequent MRI was more likely to be used in younger children and children who did not receive hyperosmotic agents, neurosurgical interventions, or intensive care unit admission (all P ‐values <0.001). Conclusions We found that repeat neuroimaging rates for children with intracranial hemorrhage vary substantially by institution. We also found that although MRI was increasingly used to re‐image these children, overall repeat neuroimaging rates (CT or MRI) have not decreased over the past decade. Future work to implement optimal utilization of neuroimaging in these children is needed.

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Leichtes Schädel-Hirn-Trauma im Kindes- und Jugendalter – Update Gehirnerschütterung

Bonfert

Wagner

Göttler

et al. 2022

Monatsschr Kinderheilkd

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Emergency department implementation of abbreviated magnetic resonance imaging for pediatric traumatic brain injury

Cited by 5 publications

References 31 publications

Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma

Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma

Trends and variation in repeat neuroimaging for children with traumatic intracranial hemorrhage

Leichtes Schädel-Hirn-Trauma im Kindes- und Jugendalter – Update Gehirnerschütterung

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