Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary

Patel, Smruti; Gozal, Yair M.; Krueger, Bryan; Bayley, James C.; Moody, Suzanne; Andaluz, Norberto; Falcone, Richard A.; Bierbrauer, Karin

doi:10.1016/j.jpedsurg.2018.04.027

Cited by 18 publications

(31 citation statements)

References 27 publications

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“…The secondary outcome in this study focused on the need for routine repeat neuroimaging following mTBI complicated by ICI, a source of ongoing debate and investigation. Although several studies have suggested that repeat neuroimaging may be low yield, 3,12,39 other studies have reported high rates of radiologic progression. 16 Given that nearly half of respondents supported ordering repeat neuroimaging but only 12% thought it was likely to change clinical management, higher level multicenter evidence is needed to guide this important decision.…”

Section: Discussionmentioning

confidence: 99%

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North American survey on the post-neuroimaging management of children with mild head injuries

Greenberg

Jeffe²,

Carpenter³

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThere remains uncertainty regarding the appropriate level of care and need for repeating neuroimaging among children with mild traumatic brain injury (mTBI) complicated by intracranial injury (ICI). This study’s objective was to investigate physician practice patterns and decision-making processes for these patients in order to identify knowledge gaps and highlight avenues for future investigation.METHODSThe authors surveyed residents, fellows, and attending physicians from the following pediatric specialties: emergency medicine; general surgery; neurosurgery; and critical care. Participants came from 10 institutions in the United States and an email list maintained by the Canadian Neurosurgical Society. The survey asked respondents to indicate management preferences for and experiences with children with mTBI complicated by ICI, focusing on an exemplar clinical vignette of a 7-year-old girl with a Glasgow Coma Scale score of 15 and a 5-mm subdural hematoma without midline shift after a fall down stairs.RESULTSThe response rate was 52% (n = 536). Overall, 326 (61%) respondents indicated they would recommend ICU admission for the child in the vignette. However, only 62 (12%) agreed/strongly agreed that this child was at high risk of neurological decline. Half of respondents (45%; n = 243) indicated they would order a planned follow-up CT (29%; n = 155) or MRI scan (19%; n = 102), though only 64 (12%) agreed/strongly agreed that repeat neuroimaging would influence their management. Common factors that increased the likelihood of ICU admission included presence of a focal neurological deficit (95%; n = 508 endorsed), midline shift (90%; n = 480) or an epidural hematoma (88%; n = 471). However, 42% (n = 225) indicated they would admit all children with mTBI and ICI to the ICU. Notably, 27% (n = 143) of respondents indicated they had seen one or more children with mTBI and intracranial hemorrhage demonstrate a rapid neurological decline when admitted to a general ward in the last year, and 13% (n = 71) had witnessed this outcome at least twice in the past year.CONCLUSIONSMany physicians endorse ICU admission and repeat neuroimaging for pediatric mTBI with ICI, despite uncertainty regarding the clinical utility of those decisions. These results, combined with evidence that existing practice may provide insufficient monitoring to some high-risk children, emphasize the need for validated decision tools to aid the management of these patients.

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Section: Discussionmentioning

confidence: 99%

“…Likewise, there remains ongoing debate and uncertainty regarding the role of and indications for repeat neuroimaging in the management of these patients. 16,21,23,39…”

Section: Introductionmentioning

confidence: 99%

North American survey on the post-neuroimaging management of children with mild head injuries

Greenberg

Jeffe²,

Carpenter³

et al. 2019

Journal of Neurosurgery: Pediatrics

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“…1 Much of the morbidity from traumatic brain injury occurs in children with intracranial hemorrhage, and clinicians closely monitor patients for hemorrhage progression with neuro-imaging techniques. [2][3][4][5][6][7][8][9] Computed tomography (CT) scans are the standard acute neuroimaging modality to both identify intracranial hemorrhage and monitor for hemorrhage progression because of its diagnostic accuracy, availability, and rapidity of results. [2][3][4][5][6][7][8][9] Children with intracranial hemorrhage undergo an average of 1-3 repeat CT scans during acute hospitalization, with 40%-88% of children undergoing at least 1 repeat CT scan.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Computed tomography (CT) scans are the standard acute neuroimaging modality to both identify intracranial hemorrhage and monitor for hemorrhage progression because of its diagnostic accuracy, availability, and rapidity of results. [2][3][4][5][6][7][8][9] Children with intracranial hemorrhage undergo an average of 1-3 repeat CT scans during acute hospitalization, with 40%-88% of children undergoing at least 1 repeat CT scan. [2][3][4][5][6][7][8][9] However, CT scans have inherent risks, particularly if they are used repeatedly.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Children with intracranial hemorrhage undergo an average of 1-3 repeat CT scans during acute hospitalization, with 40%-88% of children undergoing at least 1 repeat CT scan. [2][3][4][5][6][7][8][9] However, CT scans have inherent risks, particularly if they are used repeatedly. 10 Furthermore, radiation from CT scans increases the risk of future cancer, with the lifetime risk for fatal cancer for a child undergoing 1 brain CT estimated to be 1 in 5000.…”

Section: Introductionmentioning

confidence: 99%

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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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Role of follow-up CT scans in the management of traumatic pediatric epidural hematomas

Samples¹,

Bounajem²,

Wallace³

et al. 2019

Childs Nerv Syst

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Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary

Cited by 18 publications

References 27 publications

North American survey on the post-neuroimaging management of children with mild head injuries

North American survey on the post-neuroimaging management of children with mild head injuries

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

Role of follow-up CT scans in the management of traumatic pediatric epidural hematomas

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