Reassessing the Need for Repeat Imaging in Mild TBI
Clinical monitoring alone after initial brain imaging may be sufficient for children who have experienced mild traumatic brain injury, even when intracranial hemorrhage has occurred. This finding, part of a study led by neurosurgery experts at Cincinnati Children’s, could provide a rationale for reducing radiation exposure to these patients.
First author Smruti Patel, MD, and senior author Karin Bierbrauer, MD, led the study. It involved a retrospective chart review of 154 children who presented with an accidental brain injury that showed abnormal results on computed tomography (CT) scan.
Injury causes included falls, being struck as a pedestrian, and sports, motor vehicle and bike accidents. The treatment each patient received was in accordance with the Cincinnati Children’s minor head injury algorithm, which stratifies patients for treatment by criteria including the type and degree of initial hemorrhage.
Sixty-nine of the patients (59%) were documented as having a traumatic intracranial hemorrhage; each had repeat neuroimaging with CT 12 hours after their initial scan. Of the six patients who required neurosurgical intervention, all were identified by clinical changes rather than repeat imaging.
Routine serial surveillance CT imaging remains controversial. Few children with mild traumatic brain injury and intracranial hemorrhage, as outlined in the algorithm, experience clinically significant neurologic decline. In addition, the rare adverse events that do occur often are not identified by repeat imaging. Rather they are diagnosed because of a clinical change, such as new or worsening symptoms.
“Routine Surveillance Imaging Following Mild Traumatic Brain Injury with Intracranial Hemorrhage May Not Be Necessary” was published in the October 2018 issue of Journal of Pediatric Surgery. View the full publication and treatment algorithm.
(Published July 2023)
