Repeat Imaging Not Always Necessary After Mild Brain Injury
Published October 2018 | Journal of Pediatric Surgery
Even when intracranial hemorrhage occurs, clinical monitoring after initial imaging may be sufficient in many cases for following children who have experienced mild traumatic brain injury (mTBI), according to a study led by neurosurgery experts at Cincinnati Children’s.
A research team led by first author Smruti Patel, MD, and senior author Karin Bierbrauer, MD, conducted a retrospective chart review of 154 children who presented with accidental brain injury that showed abnormal results on computed tomography (CT) scan. Co-authors included Yair Gozal, MD, PhD, Bryan Krueger, MD, James Bayley, MD, Suzanne Moody, Norberto Andaluz, MD, and Richard Falcone Jr., MD, MPH.
Injury causes included falls (most common), being struck as a pedestrian, sports accidents, motor vehicle accidents, and bike accidents. All patients had been treated according to the Cincinnati Children’s minor head injury algorithm.
Repeat neuroimaging with CT at 12 hours after the initial scan was obtained in 69 (59%) patients with documented traumatic intracranial hemorrhage (tICH) in accordance with the Cincinnati Children’s algorithm that stratified patients for treatment by criteria including the type and degree of initial hemorrhage. Of the six patients that required neurosurgical intervention, all were identified by clinical changes rather than repeat imaging.
Given concerns about radiation exposure to still-developing brains, routine serial surveillance CT imaging remains controversial. Few children with mTBI and intracranial hemorrhage, as outlined in the algorithm, experience any clinically significant neurologic decline. In addition, the rare adverse events that do occur often are not identified by repeat imaging.
“Our study suggests that in the majority of cases, clinical monitoring alone may be safe and sufficient in patients after careful review of initial imaging in order to avoid exposure to repeat radiographic imaging,” the co-authors state.
Download Cincinnati Children's Neurosurgery Minor Head Injury Algorithm.
