Teodora Fatchikova, MD,
Surgical Resident
Cleveland Clinic Akron General
Akron, Ohio
Disclosure information not submitted.
Jessica Krizo, PhD
Research Faculty
Cleveland Clinic Akron General
Akron, Ohio, United States
Disclosure information not submitted.
Ali Mallat, MD, MS, FACS
Executive Medical Director, Acute Care Surgery
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Title: Impact of Magnetic Resonance Imaging on the Management Severe Traumatic Brain Injuries
INTRODUCTION/HYPOTHESIS:
Traumatic Brain Injury (TBI) is a leading cause of death and disability in the United States, estimated to affect 2.8 million people annually. While Computed Tomography (CT) is the primary imaging modality in the management of TBI, Magnetic Resonance Imaging (MRI) is more sensitive for the detection of axonal lesions. The purpose of this study is to identify if MRI performed greater than 24 hours after admission CT alters the clinical management of patients with moderate-severe TBI, with the hypothesis that additional imaging does not significantly alter clinical course. Secondary objectives included identifying discrepancies between MRI and CT findings and addressing the predictive value of new MRI findings.
Methods:
This was a retrospective review of adult patients who presented to an urban, level I Trauma Center, between January 1, 2016 and December 31, 2018 with moderate-severe TBI. Such TBI was defined as a head Abbreviated Injury Score (AIS) ≥3. Changes in management were defined as craniotomy, placement of intracranial drain or pressure monitor, mannitol infusion, new anti-epileptic medication, or new discussion of care goals. Identified charts were independently reviewed by three reviewers for potential changes in clinical management.
Results:
There were a total of 45 patients with moderate-severe TBI (AIS ≥3) who also had an MRI. Seven patients were excluded because MRI was completed within 24 hours of admission CT. Of the remaining 38 patients, MRI resulted in additional diagnoses compared to CT findings in one third of patients (n=13). Six patients (16%) had changes in their clinical care following MRI. Five of these six patients had new diagnoses including worsening subdural hematoma, subgaleal layering abscess, global hypoxic ischemia, and two acute infarctions not otherwise seen on CT. Changes to clinical care following MRI included placement of an intracranial drain (n=2), care withdrawal conversations (n=2), a burr hole craniotomy (n=1) and an administration of a new antibiotic (n=1).
Conclusions:
MRI has a limited role in the initial management of TBI patients. Beyond the first 24 hours, a significant number of patients may benefit from an MRI, when clinically indicated, due to possible missed injury that may alter patient management and outcome.