Artikel
Initial neuroimaging with MRI in severe pediatric head trauma
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Autoren
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P. Kunkel
- Abteilung für pädiatrische Neurochirurgie, Altonaer Kinderkrankenhaus, Hamburg
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K. Ullmann
- Abteilung für Kinder- und Jugendtraumatologie, Altonaer Kinderkrankenhaus, Hamburg
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D. Sommerfeldt
- Abteilung für Kinder- und Jugendtraumatologie, Altonaer Kinderkrankenhaus, Hamburg
| Veröffentlicht: | 28. April 2011 |
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Gliederung
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Objective: CT scanning represents standard of care in initial imaging of severe pediatric head trauma. The main purpose of neuroimaging is early and fast detection of traumatic brain injury (TBI). Radiation exposure and hence risk of radiation-induced malignancies is a clear disadvantage associated with CT scanning especially in the pediatric population. The alternative, magnetic resonance imaging (MRI) is generally considered to be too time-consuming in emergency care. We would like to put forward the hypothesis that magnetic resonance imaging (MRI) is a fast, well applicable and reliable method in emergency care. In our pediatric tertiary care center, MRI is used as the standard neuroimaging method in the initial investigation of severe head trauma cases since 2006. In this study, we analyzed the data of this patient cohort to validate MRI as the initial imaging methodology in children with severe head trauma.
Methods: We retrospectively analyzed the data of 51 consecutive cases with severe pediatric head injury imaged by MRI at our institution. The time required to conduct the imaging was obtained from radiology logs combined with data from anesthesia protocols. Complementary data was extracted from patient records.
Results: 20 girls and 31 boys underwent MRI imaging for severe head trauma between 2007 and 2009. The mean age was 6.8 years (range: 2 month to 16 years). The mean Glasgow Coma Score (GCS) after trauma was 12.5 (range: 3 to 15). In 27 of 51 (53%) MRI studies, pathological intracranial findings were seen (skull base fractures, cranial vault fractures, subdural and epidural hematomas, contusions, traumatic subarachnoid hemorrhages, diffuse axonal injuries). In 16 (31%) cases immediate or early neurosurgical intervention was performed. The mean time needed to complete the MRI study was 12.9 minutes (range: 1 to 29 minutes). In 4 children displaying clinical signs of brainstem herniation (unilateral dilated and fixed pupil) at the time of MRI execution, the mean time required for imaging was 6 minutes (range: 2 to 13 minutes). No injury of the cervical spine was found that required surgical intervention.
Conclusions: MRI imaging represents a fast and safe alternative to CT scanning in the setting of severe pediatric head trauma.
