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Feasibility of "rapid" magnetic resonance imaging in pediatric acute head injury
Ari R Cohen1, Paul Caruso2, Ann-Christine Duhaime3
1Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
Insights
Rapid MRI is a feasible option for pediatric head injuries, though it took longer than CT scans in this pilot study. Further integration may reduce delays and improve patient care for traumatic brain injuries.
Area of Science:
- Emergency Medicine
- Pediatric Radiology
- Neuroimaging
Background:
- Traumatic brain injury (TBI) in children requires prompt and accurate diagnosis.
- Noncontrast computed tomography (NCCT) is the standard imaging modality for suspected pediatric TBI.
- Rapid magnetic resonance imaging (rMRI) offers potential advantages in visualizing brain structures.
Purpose of the Study:
- To assess the feasibility of rMRI compared to NCCT for pediatric patients with possible TBI.
- To compare patient demographics and clinical characteristics between rMRI and NCCT groups.
- To evaluate emergency department (ED) length of stay (LOS) and patient outcomes.
Main Methods:
- Retrospective review of electronic medical records for pediatric patients (<19 years) with possible TBI.
- Age-matched cohort comparison of patients who underwent rMRI versus NCCT.
- Data collection included demographics, injury mechanism, ED LOS, and follow-up outcomes.
Main Results:
- The study included 45 rMRIs and 45 NCCTs; patient demographics and injury mechanisms were similar.
- rMRI had longer ED arrival-to-imaging completion (172 vs 93 min) and ED LOS (266 vs 225 min).
- NCCT group had higher acuity patients and PICU admission rates (33% vs 7%); no significant intracranial injuries were missed by either modality.
Conclusions:
- rMRI is a potentially viable imaging modality for moderate-risk pediatric head injuries.
- While rMRI had longer ED LOS in this pilot, actual scan time is short (3-4 min).
- Further integration and study are needed to optimize rMRI efficiency and assess patient satisfaction.
Objective:
The objective was to determine the feasibility of "rapid" magnetic resonance imaging (rMRI) versus noncontrast computed tomography (NCCT) for pediatric patients with possible traumatic brain injury and to compare the populations receiving imaging in an urban tertiary care emergency department ED.
Methods:
We retrospectively reviewed the electronic medical records of ED patients younger than 19 years with possible traumatic brain injury over 4 years who received an rMRI and then age-matched with NCCT patients. Data collection and analysis included demographic and clinical variables, ED length of stay (LOS), and follow-up outcomes.
Results:
The final cohort had 45 rMRIs and 45 NCCTs. The mean age was 2.7 years, 63% were male, and 65% sustained a fall. Age, sex, and injury mechanism were similar. Time parameters were longer for rMRI patients: ED arrival to completion of imaging (172 vs 93 minutes, P < .001) and ED LOS (266 vs 225 minutes, P = .008). The NCCT group had higher-acuity patients with higher pediatric intensive care unit admission rates (33% vs 7%, P = .002). No patients returned to the ED within 72 hours. Follow-up was available on 78% patients. No clinically significant intracranial injuries were missed.
Conclusions:
Rapid MRI may be a viable imaging modality for moderate-risk pediatric head injury. Although rMRI took longer to obtain during this pilot study, scan time was only 3 to 4 minutes; and LOS was only 41 minutes longer. Further integration of rMRI in patient care should decrease time variation. Future study of rMRI reliability and satisfaction is needed.
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