Trends in Early MRI Utilization in Critically Ill Children with Severe TBI: a Single Center Experience, 2010-2021
Anna Janas1, Kristen Miller2, Christopher Ruzas1, Ricka Messer3, Nicholas Stence4, Derek Samples5, Jordan Wyrwa6, Ericka Fink7, Aline Maddux1
1Pediatrics, Section of Critical Care Medicine, 2Pediatrics, 3Pediatrics, Section of Child Neurology, 4Radiology, 5Neurosurgery, 6Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, 7Critical Care Medicine, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh
Objective:
To characterize acquisition and timing of early magnetic resonance imaging (MRI) in children hospitalized with severe traumatic brain injury (TBI).
Background:
MRI identifies brain injury that may provide prognostic data. Utilization and prognostic value of MRI during the acute post-injury period in children with severe TBI are poorly characterized.
Design/Methods:
From our site’s National Trauma Data Bank, we identified children (3 to 18 years) admitted from 2010 to 2021 for severe TBI (post-resuscitation Glasgow Coma Scale [GCS] < 9) who required mechanical ventilation. We excluded patients with suspected abusive head trauma and deaths < 48 hours after presentation. We collected demographic and clinical characteristics, and acquisition and timing of MRIs obtained during hospitalization. Data were summarized as median [interquartile range] and frequency (percent). To assess practice evolution, we compared MRI utilization across three time periods (2010-2013, 2014-2017, 2018-2021) using Kruskal-Wallis and Fisher’s exact tests.
Results:
Of the 260 patients (median 11 [7-14] years; 64% boys; median GCS 3 [3-6]), 170 (65%) had an MRI with median time to MRI 3 [2-6] days. Patients who had an MRI had higher injury severity scores, more frequently underwent intracranial pressure monitoring, and had longer intensive care unit stays and durations of mechanical ventilation (p<0.05). Across the time periods, patient and injury characteristics were similar as was the proportion of patients who had an MRI. When patients did undergo MRI, it was more commonly obtained within 7 days of injury if they were admitted later in the study period (2018-2021: 67/70 (97%), 2014-2017: 50/60 (83%), 2010-2013: 28/40 (70%), p = 0.001).
Conclusions:
Although overall MRI utilization for children hospitalized with severe TBI remained stable over time, our institution is increasingly obtaining MRIs within the first 7 days. Further study is needed to determine prognostic value of early MRI.