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Abstract Details

Trends in Early MRI Utilization in Critically Ill Children with Severe TBI: a Single Center Experience, 2010-2021
Child Neurology and Developmental Neurology
P14 - Poster Session 14 (11:45 AM-12:45 PM)
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.

To characterize acquisition and timing of early magnetic resonance imaging (MRI) in children hospitalized with severe traumatic brain injury (TBI).

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.

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).

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.

Anna Janas, MD, PhD (University of Colorado Anschutz Medical Campus)
Dr. Janas has nothing to disclose.
Kristen Campbell, Other Mrs. Campbell has nothing to disclose.
Chris Ruzas, MD Dr. Ruzas has nothing to disclose.
Ricka Messer, MD (Children'S Hospital Colorado) Dr. Messer has nothing to disclose.
Nicholas Stence Nicholas Stence has nothing to disclose.
Derek Samples, MD (Children’s Hospital Colorado) Dr. Samples has nothing to disclose.
Jordan Matthew Wyrwa, DO The institution of Dr. Wyrwa has received research support from Foundation for Physical Medicine and Rehabilitation.
Ericka Fink, MD (UPMC Children's Hospital of Pittsburgh) The institution of Dr. Fink has received research support from NIH. The institution of Dr. Fink has received research support from Neurocritical Care Society. Dr. Fink has received personal compensation in the range of $500-$4,999 for serving as a Subboard member PCCM with American Board of Pediatrics.
Aline Bernard Maddux, MD (University of Colorado School of Medicine, Children's Hospital Colorado) The institution of Dr. Maddux has received research support from NIH/NICHD. The institution of Dr. Maddux has received research support from CDC.