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Use of MRI in patients with severe diffuse traumatic brain injury: A matched National Trauma Data Bank analysis
Sai Chilakapati1, Anthony J Dragun, Ryan G Chiu
1From the Department of Neurosurgery (S.C.), Baylor College of Medicine, Houston, TX 77030; and Department of Neurological Surgery (A.J.D., R.G.C., K.M.G., A.B.V.), University of Texas Southwestern Medical Center, Dallas, TX 75390.
Objective:
Magnetic resonance imaging (MRI) is increasingly used to evaluate patients with diffuse traumatic brain injury (dTBI). However, the utility of early MRI is understudied. We hypothesize that early MRI patients will have increased length of stay but no changes in intracranial pressure (ICP) management or disposition.
Methods:
The 2019 National Trauma Data Bank was queried for patients with dTBI and Glasgow Coma Scale score ≤8. Extra-axial and focal intra-axial hemorrhages were excluded. Clinical characteristics were controlled for. Patients with and without MRI were compared for ICP management, outcome, mortality, and disposition. A propensity score matching algorithm was used to create a 1:1 match cohort.
Results:
In 2568 patients, MRI was less common in severe dTBI patients with clear reasons for poor examination, including bilaterally unreactive pupils or midline shift. After matching, 501 patients who underwent MRI within 1 week were compared with 501 patients without MRI. Magnetic resonance imaging patients had longer intensive care unit stays (11.6 ± 9.6 vs. 13.4 ± 9.5, p < 0.01; 95% confidence interval [95% CI], -3.03 to -0.66). There was no difference between groups in ICP monitor (23.6% vs. 27.3%; p = 0.17; 95% CI, -0.09 to 0.02) or ventriculostomy placement (13.6% vs. 13.2%, p = 0.85; 95% CI, -0.04 to 0.05) or in withdrawal of care (15.0% vs. 18.6%, p = 0.12; 95% CI, -0.08 to 0.01). MRI patients were more likely to be discharged to inpatient rehabilitation (42.9% vs. 33.5%; p < 0.01; 95% CI, 0.03-0.15) but not to home (9.4% vs. 9.0%; p = 0.83; 95% CI, -0.03 to 0.04).
Conclusion:
The decision to pursue early brain MRI may be driven by lack of obvious reasons for a patient's poor neurologic status. MRI patients had longer intensive care unit stays but no difference in rates of placement of ICP monitors or ventriculostomies or withdrawal of care. Further study is required to define the role of early MRI in dTBI patients.
Level Of Evidence:
Prognostic and Epidemiological; Level IV.
Insights
Early magnetic resonance imaging (MRI) for diffuse traumatic brain injury (dTBI) is associated with longer intensive care unit stays but does not alter intracranial pressure management or patient disposition outcomes.
Area of Science:
- Neuroscience
- Radiology
- Trauma Surgery
Background:
- Diffuse traumatic brain injury (dTBI) evaluation increasingly utilizes magnetic resonance imaging (MRI).
- The clinical utility and impact of early MRI in dTBI patients remain understudied.
- This study investigates the association between early MRI and patient management and outcomes in dTBI.
Purpose of the Study:
- To determine if early MRI in dTBI patients affects intracranial pressure (ICP) management.
- To assess the impact of early MRI on patient disposition and overall outcomes.
- To test the hypothesis that early MRI leads to increased length of stay without altering ICP management or disposition.
Main Methods:
- A retrospective analysis of the 2019 National Trauma Data Bank was performed.
- Patients with dTBI and Glasgow Coma Scale score ≤8, excluding specific hemorrhage types, were included.
- A propensity score matching algorithm created a 1:1 cohort comparing patients with and without MRI within one week.
Main Results:
- MRI patients experienced longer intensive care unit (ICU) stays (13.4 vs. 11.6 days).
- No significant differences were observed in ICP monitor or ventriculostomy placement rates between groups.
- MRI patients were more likely to be discharged to inpatient rehabilitation, not home.
Conclusions:
- Early MRI in dTBI is associated with increased ICU length of stay.
- Early MRI does not appear to influence critical management decisions like ICP monitoring or withdrawal of care.
- Further research is needed to clarify the precise role and benefits of early MRI in managing dTBI patients.
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