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Imaging is the primary method for diagnosing traumatic brain injury (TBI), but unnecessary scans, especially in children and adolescents, should be minimized. Clinical decision-making rules aid in identifying patients requiring imaging; however, when spinal trauma is suspected, concomitant brain imaging is frequently performed. The prevalence of co-occurring brain and spine injuries in asymptomatic patients remains uncertain.
This study evaluates the diagnostic yield of brain MRI in pediatric patients who present with suspected or confirmed accidental spinal trauma but exhibit no symptoms indicative of brain injury. The retrospective review focused on pediatric patients under 18 years who underwent simultaneous MRI of the brain and spine due to acute spinal trauma in the emergency radiology department over eight years. The study compared brain MRI results of patients exhibiting symptoms suggestive of brain injury against those without such symptoms and assessed the findings across both imaging modalities.
Among 179 pediatric patients participating in the study, the average age was 11.7 years, with a range from 0 to 17 years. Out of these, 137 presented symptoms or findings reflecting potential brain injury, whereas 42 did not. Notably, all patients lacking symptoms of brain injury had unremarkable brain MRI findings. This outcome persisted in patients involved in high-energy trauma scenarios and bore no correlation to spinal MRI results.
Pediatric patients with accidental spinal trauma, but without any indicators of brain injury, do not appear to gain from brain imaging. TBI remains a considerable health issue globally, with emergency department visits due to suspected brain injuries being prevalent. Reports indicate escalating trends in pediatric TBI cases, including those due to both sports and non-sport-related incidents, alongside rising overall trauma-related emergency visits.
The question of whether to conduct imaging arises frequently in emergency scenarios involving children suspected of sustaining head injuries. Clinical decision-making tools such as PECARN, CATCH, and CHALICE serve to evaluate the necessity for imaging with high sensitivity. Nevertheless, in practice, children predominantly suspected of spinal injury but exhibiting no risk factors for brain injury frequently undergo concurrent brain and spine imaging. The specific risk of concurrent spinal trauma indicating brain injury in accidental cases remains to be firmly established.
This study was conducted at a tertiary care referral center serving approximately 470,000 individuals, retrospectively analyzing the medical charts of patients aged under 18 who received emergency spinal MRI alongside brain MRI from April 1, 2013, to August 31, 2021. Patients were included based on the dual criteria of receiving emergency spinal MRI and concurrent brain MRI. Exclusions consisted of individuals with primary MRI indications unrelated to blunt trauma and those without clinical indicators of thoracolumbar spine injury.
Data collection involved extracting imaging reports and medical records detailing injury mechanisms, demographic profiles, and clinical variables. Symptoms and signs suggestive of potential head injury, such as headache, confusion, altered consciousness, or seizures, were carefully documented. Classical clinical decision rules for assessing brain injury risks were not deployed due to the nature of the records, but the Glasgow Coma Scale was utilized in assessing consciousness level.
A majority of the patients scanned, 89.9%, were fully conscious, with sedated patients typically intubated for severe neurological or non-neurological issues. Essential imaging was performed on a Philips Ingenia 3-T MRI system, using established protocols for brain and spinal imaging. Radiologists with substantial experience conducted the interpretations. The results revealed that brain MRA findings of traumatic etiology were present in 25 cases (14%), with all instances correlating to neurological symptoms indicative of brain injury. In stark contrast, no traumatic findings appeared in patients lacking such symptoms.
The data suggests the absence of correlation between findings of spine and brain MRIs, indicating no predictive value for spinal injuries regarding potential brain injuries. Of the 42 patients without brain injury symptoms, 33% exhibited spinal MRI findings unrelated to brain trauma. Incidental non-traumatic MRI results occurred in 13% of patients, with only a negligible rate resulting in further medical intervention.
This study highlights the critical need to evaluate and potentially redefine imaging practices in pediatric patients with suspected spinal trauma devoid of brain injury symptoms. Given the established superiority of clinical decision-making guidelines, findings advocate for established protocols when determining the need for head imaging in this specific patient demographic.
Conclusively, pediatric trauma patients with suspected spinal injuries, absent brain injury symptoms, have limited necessity for concurrent brain MRI. Further research is warranted to confirm these observations on a larger scale. An approach grounded in clinical guidelines will enhance patient management while mitigating unnecessary imaging in vulnerable populations.
No datasets were generated during this study, though research was supported via various funding organizations. Ethical review board approval was not required due to retrospective study design, and the authors declared no competing interests.
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