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Utility of surveillance imaging after minor blunt head trauma
Joshua J Chern1, Samir Sarda, Brian M Howard
1Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta;
Insights
Adverse events following pediatric blunt head trauma are rare. Routine surveillance imaging after mild traumatic brain injury does not appear to improve outcomes or identify surgical needs.
Area of Science:
- Pediatric Traumatology
- Neurotrauma Research
- Clinical Outcomes Analysis
Background:
- Nonoperative blunt head trauma is a frequent cause of pediatric hospital admissions.
- The incidence of adverse events, like growing skull fractures, is largely unknown, complicating optimal follow-up care strategies.
- Current guidelines for post-injury surveillance lack clarity due to limited data on morbidity.
Purpose of the Study:
- To determine the incidence of adverse events in children admitted for nonoperative blunt head trauma.
- To analyze the utilization and effectiveness of post-discharge surveillance imaging.
- To inform optimal follow-up care protocols for pediatric mild traumatic brain injury.
Main Methods:
- A retrospective review of 937 pediatric admissions for minor blunt head trauma (May 2009-April 2013).
- Data collected included demographics, clinical characteristics, emergency department (ED) visits, surgical procedures, clinic visits, and surveillance imaging within 180 days post-discharge.
- Statistical methods were used to analyze associations between clinical events and potential contributing factors.
Main Results:
- Adverse events were infrequent, with 34 ED visits and 3 surgeries among 937 admissions.
- 71.7% of patients attended follow-up visits, with surveillance imaging used in 343 instances.
- Surveillance imaging patterns correlated with physician identity, not injury severity, and did not demonstrate a positive influence on outcomes.
Conclusions:
- Adverse events are rare following nonoperative mild traumatic brain injury in children.
- Routine post-injury surveillance imaging is of questionable value, as it did not effectively identify patients requiring operative intervention.
- Further research may refine follow-up care, but current data suggest limited benefit from routine surveillance imaging.
Object:
Nonoperative blunt head trauma is a common reason for admission in a pediatric hospital. Adverse events, such as growing skull fracture, are rare, and the incidence of such morbidity is not known. As a result, optimal follow-up care is not clear.
Methods:
Patients admitted after minor blunt head trauma between May 1, 2009, and April 30, 2013, were identified at a single institution. Demographic, socioeconomic, and clinical characteristics were retrieved from administrative and outpatient databases. Clinical events within the 180-day period following discharge were reviewed and analyzed. These events included emergency department (ED) visits, need for surgical procedures, clinic visits, and surveillance imaging utilization. Associations among these clinical events and potential contributing factors were analyzed using appropriate statistical methods.
Results:
There were 937 admissions for minor blunt head trauma in the 4-year period. Patients who required surgical interventions during the index admission were excluded. The average age of the admitted patients was 5.53 years, and the average length of stay was 1.7 days; 15.7% of patients were admitted for concussion symptoms with negative imaging findings, and 26.4% of patients suffered a skull fracture without intracranial injury. Patients presented with subdural, subarachnoid, or intraventricular hemorrhage in 11.6%, 9.19%, and 0.53% of cases, respectively. After discharge, 672 patients returned for at least 1 follow-up clinic visit (71.7%), and surveillance imaging was obtained at the time of the visit in 343 instances. The number of adverse events was small and consisted of 34 ED visits and 3 surgeries. Some of the ED visits could have been prevented with better discharge instructions, but none of the surgery was preventable. Furthermore, the pattern of postinjury surveillance imaging utilization correlated with physician identity but not with injury severity. Because the number of adverse events was small, surveillance imaging could not be shown to positively influence outcomes.
Conclusions:
Adverse events after nonoperative mild traumatic injury are rare. The routine use of postinjury surveillance imaging remains controversial, but these data suggest that such imaging does not effectively identify those who require operative intervention.
