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Routine Surveillance Imaging Following Mild Traumatic Brain Injury May Not Be Necessary
Smruti K. Patel, MD, OH Yair M. Gozal, MD, PhD, James Bayley, BS, Bryan M. Krueger, MD and Norberto Andaluz, MD, University of Cincinnati College of Medicine, Cincinnati OH; Richard A. Falcone Jr., MD, MPH and Karin S. Bierbrauer, MD, Cincinnati Children's Hospital Medical Center, Cincinnati OH

Abstract: Purpose Mild traumatic brain injury (mTBI) comprises the majority of pediatric TBI. Children with mTBI and intracranial hemorrhage (ICH) rarely experience a clinically significant neurologic decline (CSND). The utility of routine surveillance imaging also remains controversial. This study aims to identify demographic or injury-related characteristics that may facilitate recognition of at-risk children with mTBI. Methods We performed a retrospective review of patients <16 yo with mTBI (GCS 13-15) and ICH admitted to a Level I pediatric trauma center between 2009 and 2014. Management of these patients was directed by utilizing our Minor Head Injury Algorithm. We reviewed each chart for patient demographics, injury-specific data, and radiographic or clinical progression. Results 154 patients met inclusion criteria with mean age of 4 [0-16]; 116 sustained an ICH and 38 patients had isolated skull fractures. Repeat neuroimaging was obtained in 68 patients (59%). Only 9 patients (13%) with ICH had radiographic progression, none of which had CSND; in addition, 9 experienced CSND and 6 required neurosurgical intervention, none of whom had repeat imaging prior to their neurologic changes. Both CSND and need for intervention were significantly higher in patients with epidural hematomas than other types of ICH (19.2% vs. 1.1%, p = 0.002). No other characteristics were found to be significant. Conclusion Few children with mTBI and ICH experience clinical decline. Importantly all patients that required neurosurgical intervention were identified by clinical changes and not by repeat imaging. Further evaluation of the use of and indications for routine repeat imaging is needed.

Objective:
To identify demographic or injury-relatied characteristics that may facilitate recognition of at-risk pediatric patients with mild traumatic brain injury and if routine surveillance imaging is indicated as part of the management in children with mild TBI.

Objective Content: Purpose: Mild traumatic brain injury (mTBI) comprises the majority of pediatric TBI. Children with mTBI and intracranial hemorrhage (ICH) rarely experience a clinically significant neurologic decline (CSND). The utility of routine surveillance imaging also remains controversial. This study aims to identify demographic or injury-related characteristics that may facilitate recognition of at-risk children with mTBI.


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