Comparative Analysis of Repeat Cranial Imaging in Mild Traumatic Brain Injury: Evaluating Risk Factors, Costs, and...

Area of Science:

• Neurology
• Radiology
• Trauma Care

Background:

• Mild traumatic brain injury (mTBI) patients undergo frequent cranial imaging with limited diagnostic value.
• This study evaluates the impact of repeat imaging on mTBI patient management, costs, and radiation exposure.

Purpose of the Study:

• To assess the clinical utility and resource implications of repeat cranial imaging in mild traumatic brain injury (mTBI) patients.
• To analyze trends in imaging utilization, costs, and radiation exposure over time.

Main Methods:

• Retrospective analysis of consecutive mTBI patients from 2017 and 2023 at a trauma center.
• Inclusion of cranial computed tomography (CT) and imaging studies up to 90-day follow-up.
• Primary endpoints included delayed neurosurgical intervention or death.

Main Results:

• Intracranial hemorrhage (IH) was identified in 98 patients in 2017 and 81 in 2023.
• 27% of patients with initial IH showed progression on repeat imaging, necessitating 11 delayed neurosurgical interventions.
• Skull fractures predicted IH progression; patients on anticoagulants/antiplatelets without initial IH had more repeat CTs in 2017, leading to higher costs and radiation exposure (262,833 CHF in 2017).

Conclusions:

• Repeat imaging for mTBI minimally impacts clinical decisions, even with a notable risk of intracranial hemorrhage progression, unless clinical deterioration occurs.
• A trend towards reduced CT utilization and lower radiation doses was observed, highlighting the need for optimized resource allocation for patients without initial IH.