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Updated: Feb 10, 2026
Advanced Diffusion Imaging in The Hippocampus of Rats with Mild Traumatic Brain Injury
Published on: August 14, 2019
Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary
Smruti K Patel1, Yair M Gozal1, Bryan M Krueger1
1Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH.
Insights
Few children with mild traumatic brain injury (mTBI) and traumatic intracranial hemorrhage (tICH) experience decline. Clinical monitoring alone is sufficient, avoiding unnecessary radiation exposure from repeat imaging.
Area of Science:
- Pediatric neurosurgery
- Trauma care
- Radiology
Background:
- Mild traumatic brain injury (mTBI) is common in children, often without severe outcomes, even with traumatic intracranial hemorrhage (tICH).
- Routine surveillance imaging in pediatric mTBI is debated due to radiation risks.
- Identifying children at risk for mTBI progression is crucial.
Purpose of the Study:
- To identify demographic and injury-related factors predicting progression in pediatric mTBI patients.
- To evaluate the necessity of routine surveillance imaging in pediatric mTBI with tICH.
Main Methods:
- Retrospective review of pediatric patients (<16 years) with mTBI and tICH.
- Analysis of patient demographics, injury details, and clinical/radiographic progression.
- Utilized the Cincinnati Children's Hospital Medical Center Minor Head Injury Algorithm.
Main Results:
- Only 13% of tICH patients showed radiographic progression, with no associated clinically significant neurologic decline (CSND).
- CSND occurred in 9 patients, requiring neurosurgical intervention in 6; none had prior repeat imaging.
- Epidural hematomas were associated with significantly higher rates of CSND and intervention.
Conclusions:
- Most children with mTBI and tICH do not experience clinical decline.
- Clinical changes, not repeat imaging, identified patients needing intervention.
- Clinical monitoring is generally sufficient, reducing radiation exposure from repeat imaging.
Background:
Mild traumatic brain injury (mTBI) comprises the majority of pediatric traumatic brain injury. Children with mTBI even with traumatic intracranial hemorrhage (tICH) rarely experience a clinically significant neurologic decline (CSND). The utility of routine surveillance imaging in the pediatric population also remains controversial, especially owing to concerns about the risks of radiation exposure at a young age. This study aims to identify demographic or injury-related characteristics that may facilitate recognition of children at risk of progression with mTBI.
Methods:
We performed a retrospective review of patients <16 years old with mTBI (GCS 13-15) and tICH admitted to a Level I pediatric trauma center between 2009 and 2014. Management of these patients was directed by the Cincinnati Children's Hospital Medical Center Minor Head Injury Algorithm. We reviewed each chart with emphasis on patient demographics, injury specific data, and radiographic or clinical progression.
Results:
154 patients met inclusion criteria with mean age of 4 [0-16]; 116 sustained an tICH and 38 patients had isolated skull fractures. Repeat neuroimaging was obtained in 68 patients (59%). Only 9 patients (13%) with tICH had radiographic progression, none of which resulted in CSND. In addition, 9 patients experienced CSND, leading to neurosurgical intervention in 6 patients. Notably, none of these patients had repeat imaging prior to their neurologic changes. Both CSND and need for intervention were significantly higher in patients with epidural hematomas than other types of tICH (19.2% vs. 1.1%, p = 0.002). Of 154 patients, 19 did not have documented follow-up, 135 were seen as outpatients and 65 (48%) had follow up neuroimaging. All patients who had surveillance imaging in the outpatient setting had stable or resolved tICH.
Conclusion:
Few children with mTBI and tICH experience clinical decline. Importantly, all patients that required neurosurgical intervention were identified by clinical changes rather than via repeat imaging. Our study suggests that in the vast majority of cases, clinical monitoring alone is safe and sufficient in patients in order to avoid exposure to repeat radiographic imaging.
Level Of Evidence:
Level III, prognostic and epidemiological.
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