scholarly journals Magnetic resonance imaging as an alternative to computed tomography in select patients with traumatic brain injury: a retrospective comparison

2015 ◽  
Vol 15 (5) ◽  
pp. 529-534 ◽  
Author(s):  
Marie Roguski ◽  
Brent Morel ◽  
Megan Sweeney ◽  
Jordan Talan ◽  
Leslie Rideout ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Scan ◽  
Intracranial Hemorrhage ◽  
Skull Fracture ◽  
Ct Scanning ◽  
Skull Fractures ◽  
Radiology Reports ◽  
Subdural Hematomas ◽  
The Mean ◽  
Ct And Mri

OBJECT Traumatic head injury (THI) is a highly prevalent condition in the United States, and concern regarding excess radiation-related cancer mortality has placed focus on limiting the use of CT in the evaluation of pediatric patients with THI. Given the success of rapid-acquisition MRI in the evaluation of ventriculoperitoneal shunt malfunction in pediatric patient populations, this study sought to evaluate the sensitivity of MRI in the setting of acute THI. METHODS Medical records of 574 pediatric admissions for THI to a Level 1 trauma center over a 10-year period were retrospectively reviewed to identify patients who underwent both CT and MRI examinations of the head within a 5-day period. Thirty-five patients were found, and diagnostic images were available for 30 patients. De-identified images were reviewed by a neuroradiologist for presence of any injury, intracranial hemorrhage, diffuse axonal injury (DAI), and skull fracture. Radiology reports were used to calculate interrater reliability scores. Baseline demographics and concordance analysis was performed with Stata version 13. RESULTS The mean age of the 30-patient cohort was 8.5 ± 6.7 years, and 63.3% were male. The mean Injury Severity Score was 13.7 ± 9.2, and the mean Glasgow Coma Scale score was 9 ± 5.7. Radiology reports noted 150 abnormal findings. CT scanning missed findings in 12 patients; the missed findings included DAI (n = 5), subarachnoid hemorrhage (n = 6), small subdural hematomas (n = 6), cerebral contusions (n = 3), and an encephalocele. The CT scan was negative in 3 patients whose subsequent MRI revealed findings. MRI missed findings in 13 patients; missed findings included skull fracture (n = 5), small subdural hematomas (n = 4), cerebral contusions (n = 3), subarachnoid hemorrhage (n = 3), and DAI (n = 1). MRI was negative in 1 patient whose preceding CT scan was read as positive for injury. Although MRI more frequently reported intracranial findings than CT scanning, there was no statistically significant difference between CT and MRI in the detection of any intracranial injury (p = 0.63), DAI (p = 0.22), or intracranial hemorrhage (p = 0.25). CT scanning tended to more frequently identify skull fractures than MRI (p = 0.06). CONCLUSIONS MRI may be as sensitive as CT scanning in the detection of THI, DAI, and intracranial hemorrhage, but missed skull fractures in 5 of 13 patients. MRI may be a useful alternative to CT scanning in select stable patients with mild THI who warrant neuroimaging by clinical decision rules.

scholarly journals Diagnostic and Clinical Management of Skull Fractures in Children

2016 ◽  
Vol 6 ◽  
pp. 47
Author(s):  
Christoph Arneitz ◽  
Maria Sinzig ◽  
Günter Fasching
Keyword(s):  
Hospital Stay ◽  
Head Trauma ◽  
Clinical Management ◽  
Skull Fracture ◽  
Neurological Symptoms ◽  
Ct Scans ◽  
Skull Fractures ◽  
X Rays ◽  
Minor Head Trauma ◽  
The Mean

Objective: The indications of routine skull X-rays after mild head trauma are still in discussion, and the clinical management of a child with a skull fracture remains controversial. The aim of our retrospective study was to evaluate our diagnostic and clinical management of children with skull fractures following minor head trauma. Methods: We worked up the medical history of all consecutive patients with a skull fracture treated in our hospital from January 2009 to October 2014 and investigated all skull X-rays in our hospital during this period. Results: In 5217 skull radiographies, 66 skull fractures (1.3%) were detected. The mean age of all our patients was 5.9 years (median age: 4.0 years); the mean age of patients with a diagnosed skull fracture was 2.3 years (median age: 0.8 years). A total of 1658 children (32%) were <2 years old. A typical boggy swelling was present in 61% of all skull fractures. The majority of injuries were caused by falls (77%). Nine patients (14%) required a computed tomography (CT) scan during their hospital stay due to neurological symptoms, and four patients had a brain magnetic resonance imaging. Nine patients (14%) showed an intracranial hemorrhage (ICH; mean age: 7.3 years); one patient had a neurosurgery because of a depressed skull fracture. Nine patients (14%) were observed at our pediatric intensive care unit for a mean time of 2.9 days. The mean hospital stay was 4.2 days. Conclusions: Our findings support previous evidence against the routine use of skull X-rays for evaluation of children with minor head injury. The rate of diagnosed skull fractures in radiographs following minor head trauma is low, and additional CT scans are not indicated in asymptomatic patient with a linear skull fracture. All detected ICHs could be treated conservatively. Children under the age of 2 years have the highest risk of skull fractures after minor head trauma, but do not have a higher incidence of intracranial bleeding. Neuroobservation without initial CT scans is safe in infants and children following minor head trauma and CT scans should be reserved for patients with neurological symptoms.

Abstract W P187: Utilization of Emergency Medical Services to Transfer Acute Stroke Patients Directly to Scanning Reduces the Length of Time to Scan Result

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Scott Dunbar ◽  
Theresa Hoffecker ◽  
Avery Schwenk
Keyword(s):  
Acute Stroke ◽  
Ct Scan ◽  
Emergency Medical Services ◽  
Ct Scanning ◽  
Medical Services ◽  
Time Of Arrival ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Number Of Patients ◽  
The Mean

Background: Rapid assessment and treatment of acute stroke patients including computerized tomography (CT) scanning to determine the need for tissue plasminogen activator (tPA) has been shown to be vital to positive patient outcomes. As part of an ongoing effort to reduce door-to-needle time for such patients, the door-to-CT result time was identified as an area that could be reduced by collaborative effort between Emergency Medical Services (EMS) and Emergency Department (ED) staff. We hypothesized that implementing an EMS protocol for direct-to-CT scanning as part of a collaborative stroke alert protocol would reduce overall door-to-CT result time. Methods: Local EMS and ED implemented criteria to alert the ED of acute stroke patients being transported to their facility. This alert included an estimated time of arrival and was sent to radiology, neurology, registration and pharmacy. Upon arrival, the patient was met by ED personnel while still on the EMS gurney. If the ED physician concurred with the field impression of acute stroke, the patient was taken directly to CT scanning by EMS. Data on time of door-to-CT result were collected from 7/9/12 to 7/8/13 and divided into those patients who received a stroke alert from EMS (n=41), and those who did not (n=81). All data are expressed as mean ± standard error. Results: The time for door-to-CT result was reduced (p<0.0001) for patients who received a stroke alert from EMS [16.5 ± 1.2 vs 31.6 ± 1.5 minutes, alert vs no alert, respectively]. Similarly, in the subset of patients who received tPA after the CT scan, the mean time door-to-CT scan results was reduced (p<0.005) in those patients who received a stroke alert from EMS (14.3 ± 1.1 vs 36.4 ± 7.3 minutes, alert vs no alert, respectively). Conclusions: Implementation of a stroke alert including a direct-to-CT protocol by EMS significantly reduced the mean door-to-CT result time in acute stroke patients. Expanding this protocol to include other area EMS services and hospitals could potentially result in a greater number of patients benefiting from these reduced times.

scholarly journals Head injury from falls in children younger than 6 years of age

2015 ◽  
Vol 100 (11) ◽  
pp. 1032-1037 ◽  
Author(s):  
P Burrows ◽  
L Trefan ◽  
R Houston ◽  
J Hughes ◽  
G Pearson ◽  
...  
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Skull Fracture ◽  
Cross Sectional Study ◽  
Skull Fractures ◽  
Sectional Study ◽  
Intracranial Injury ◽  
Cross Sectional ◽  
Serious Injury ◽  
The Relationship

The risk of serious head injury (HI) from a fall in a young child is ill defined. The relationship between the object fallen from and prevalence of intracranial injury (ICI) or skull fracture is described.MethodCross-sectional study of HIs from falls in children (<6 years) admitted to UK hospitals, analysed according to the object fallen from and associated Glasgow Coma Score (GCS) or alert, voice, pain, unresponsive (AVPU) and CT scan results.ResultsOf 1775 cases ascertained (median age 18 months, 54.7% boys), 87% (1552) had a GCS=15/AVPU=alert. 19.3% (342) had a CT scan: 32% (110/342) were abnormal; equivalent to 5.9% of the overall population, 16.9% (58) had isolated skull fractures and 13.7% (47) had ICI (49% (23/47) had an associated skull fracture). The prevalence of ICI increased with neurological compromise; however, 12% of children with a GCS=15/AVPU=alert had ICI. When compared to falls from standing, falls from a person's arms (233 children (mean age 1 year)) had a significant relative OR for a skull fracture/ICI of 6.94 (95% CI 3.54 to 13.6), falls from a building (eg, window or attic) (mean age 3 years) OR 6.84 (95% CI 2.65 to 17.6) and from an infant or child product (mean age 21 months) OR 2.75 (95% CI 1.36 to 5.65).ConclusionsMost HIs from a fall in these children admitted to hospital were minor. Infants, dropped from a carer's arms, those who fell from infant products, a window, wall or from an attic had the greatest chance of ICI or skull fracture. These data inform prevention and the assessment of the likelihood of serious injury when the object fallen from is known.

scholarly journals Linear nondisplaced skull fractures in children: who should be observed or admitted?

2015 ◽  
Vol 16 (6) ◽  
pp. 703-708 ◽  
Author(s):  
Eliel N. Arrey ◽  
Marcia L. Kerr ◽  
Stephen Fletcher ◽  
Charles S. Cox ◽  
David I. Sandberg
Keyword(s):  
Hospital Stay ◽  
Mental Status ◽  
Skull Fracture ◽  
Altered Mental Status ◽  
Neurological Deficits ◽  
Skull Fractures ◽  
Fractures In Children ◽  
The Mean ◽  
Clinical Records

OBJECT In this study the authors reviewed clinical management and outcomes in a large series of children with isolated linear nondisplaced skull fractures (NDSFs). Factors associated with hospitalization of these patients and costs of management were also reviewed. METHODS After institutional review board approval, the authors retrospectively reviewed clinical records and imaging studies for patients between the ages of 0 and 16 years who were evaluated for NDSFs at a single children’s hospital between January 2009 and December 2013. Patients were excluded if the fracture was open or comminuted. Additional exclusion criteria included intracranial hemorrhage, more than 1 skull fracture, or pneumocephalus. RESULTS Three hundred twenty-six patients met inclusion criteria. The median patient age was 19 months (range 2 weeks to 15 years). One hundred ninety-three patients (59%) were male and 133 (41%) were female. One hundred eighty-four patients (56%) were placed under 23-hour observation, 87 (27%) were admitted to the hospital, and 55 patients (17%) were discharged from the emergency department. Two hundred seventy-eight patients (85%) arrived by ambulance, 36 (11%) arrived by car, and 12 (4%) were airlifted by helicopter. Two hundred fifty-seven patients (79%) were transferred from another institution. The mean hospital stay for patients admitted to the hospital was 46 hours (range 7–395 hours). The mean hospital stay for patients placed under 23-hour observation status was 18 hours (range 2–43 hours). The reasons for hospitalization longer than 1 day included Child Protective Services involvement in 24 patients and other injuries in 11 patients. Thirteen percent (n = 45) had altered mental status or loss of consciousness by history. No patient had any neurological deficits on examination, and none required neurosurgical intervention. Less than 16% (n = 50) had subsequent outpatient follow-up. These patients were all neurologically intact at the follow-up visit. CONCLUSIONS Hospitalization is not necessary for many children with NDSFs. Patients with mental status changes, additional injuries, or possible nonaccidental injury may require observation.

scholarly journals Clinical Impact of Hemorrhagic Lesion Progression Following Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

2021 ◽  
Author(s):  
Alexander Fletcher-Sandersjöö ◽  
Charles Tatter ◽  
Jonathan Tjerkaski ◽  
Jiri Bartek ◽  
Marc Maegele ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Regression Analysis ◽  
Cohort Study ◽  
Brain Injury ◽  
Ct Scan ◽  
Intracranial Hemorrhage ◽  
Observational Cohort Study ◽  
Traumatic Intracranial Hemorrhage ◽  
Observational Cohort ◽  
The Mean

Abstract Background Hemorrhage progression following traumatic brain injury (TBI) is not fully understood, and preventing it would be a potential therapeutic opportunity in TBI management. The aim of this study was to determine how non-operated hemorrhagic lesions progress following TBI, and how this affects outcome. Methods This was a retrospective observational cohort study of adult patients (≥ 15 years) with moderate-to-severe TBI. Hemorrhage volumes were calculated from computed tomography (CT) scans using semi-automated volumetric segmentation. Results In total, 643 patients were included, with a median Glasgow Coma Scale of 7. Contusions were the most common form of traumatic intracranial hemorrhage. The mean total lesion volume on the first CT scan was 4.29 ml, and the mean lesion progression volume (LPV), i.e. the increase in volume from first CT scan until the lesion had stopped progressing, was 3.85 ml. Contusions showed a significantly larger LPV than SDH and EDH (p < 0.001). The median lesion progression time (LPT), i.e. the time from injury until all lesions had stopped progressing, was 5.98 hours, with contusions progressing for a longer time than tSAH, SDH and EDH (p < 0.001). Hemorrhage progression also slowed exponentially over time, with almost no further expansion occurring 24 hours after trauma. In multivariable regression analysis, LPV was independently associated with 12-month Glasgow Outcome Score after adjusting for known TBI outcome predictors (p < 0.001). Conclusions Contusions were the most common form of traumatic intracranial hemorrhage, and exhibited both a larger LPV and longer LPT than extra-axial hematomas. Regression analysis indicated that LPV was independently related to, and possibly a driver of, unfavorable outcome. Interventions to prevent lesion progression are therefore likely to improve outcome in TBI patients. Moreover, this study suggests a wider window of opportunity to prevent lesion progression than what has previously been suggested.

Evaluation of Neonatal Intracranial Hemorrhage by Computerized Tomography

PEDIATRICS ◽  
1977 ◽  
Vol 59 (2) ◽  
pp. 165-172
Author(s):  
K. S. Krishnamoorthy ◽  
R. A. Fernandez ◽  
K. J. Momose ◽  
G. R. DeLong ◽  
Fergus M. B. Moylan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Ct Scan ◽  
Intracranial Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Ct Scans ◽  
Brain Scan ◽  
Continued Use ◽  
Ct Brain

Computerized tomographic (CT) brain scan was performed on 28 infants with unexplained cardiorespiratory and neurologic deterioration and bloody lumbar cerebrospinal spinal fluid. Fourteen of 20 with intraventricular hemorrhage (IVH) died; the six infants with lesser degrees of IVH survived. Significant subarachnoid hemorrhage (SAH) was demonstrable in three infants and three had negative scans despite bloody CSF. We have found that CT scans provide useful information about the size and extent of neonatal IVH and distinguishes it from SAH. It also confirms the diagnosis of post-hemorrhagic hydrocephalus in these infants. Continued use of the CT scan will help us to understand the natural history and the effects of neonatal intracranial hemorrhage among the survivors of intensive care.

scholarly journals Alternative oblique head CT scanning technique reduces bone artifact and improves interpretability of brainstem anatomy

2010 ◽  
Vol 2 (1) ◽  
pp. 14 ◽  
Author(s):  
Sam Douglas Kampondeni ◽  
Gretchen Lano Birbeck ◽  
Robert J. Oostveen ◽  
Colleen Hammond ◽  
Michael James Potchen
Keyword(s):  
Posterior Fossa ◽  
Multislice Ct ◽  
Ct Scanning ◽  
Spiral Ct ◽  
Single Slice ◽  
Scanning Technique ◽  
Head Positioning ◽  
Ethical Approval ◽  
The Mean ◽  
Ct And Mri

Brainstem pathology due to infections, infarcts and tumors are common in developing countries, but neuroimaging technology in these resource-poor settings is often limited to single slice, and occasionally spiral, CT. Unlike multislice CT and MRI, single slice and spiral CT are compromised by bone artifacts in the posterior fossa due to the dense petrous bones, often making imaging of the brainstem non-diagnostic. With appropriate head positioning, the petrous ridges can be avoided with 40˚ sagittal oblique scans parallel to either petrous ridge. We describe an alternative sagittal oblique scanning technique that significantly reduces brainstem CT artifacts thereby improving clarity of anatomy. With Inst&shy;itutional Ethical approval, 13 adult patients were enrolled (5 males; 39%). All patients had routine axial brain CT and sagittal oblique scans with no lesions found. Images were read by 2 readers who gave a score for amount of artefact and clarity of structures in the posterior fossa. The mean artifact score was higher for routine axial images compared to sagittal oblique (2.92 vs. 1.23; P&lt;0.0001). The mean anatomical certainty scores for the brainstem were significantly better in the sagittal oblique views compared to routine axial (1.23 vs. 2.77; P&lt;0.0001). No difference was found between the two techniques with respect to the fourth ventricle or the cerebellum (axial vs. sag oblique: 1.15 vs. 1.27; P=0.37). When using single slice CT, the sagittal oblique scanning technique is valuable in improving clarity of anatomy in the brainstem if axial images are non-diagnostic due to bone artifacts.

Bilateral Interhemispheric Subdural Hematomas

Neurosurgery ◽  
1979 ◽  
Vol 5 (1) ◽  
pp. 57-59 ◽  
Author(s):  
David L. Kasdon Major ◽  
Michael R. Magruder ◽  
Edwin A. Stevens ◽  
Wayne S. Paullus
Keyword(s):  
Ct Scan ◽  
Head Trauma ◽  
Ventriculoperitoneal Shunt ◽  
Clinical Presentation ◽  
Ct Scanning ◽  
Review Of The Literature ◽  
Subdural Hematomas

abstract Interhemispheric subdural hematomas are rare. Bilateral interhemispheric subdural hematomas in a patient with a ventriculoperitoneal shunt for hydrocephalus were diagnosed by computerized tomographic (CT) scan after mild head trauma. The value of CT scanning, the clinical presentation and treatment, and a review of the literature are presented.

scholarly journals Is the skull x-ray a useful tool in paediatric blunt head injury and are we familiar with an abnormal finding?

2001 ◽  
Vol 5 (1) ◽  
pp. 45-47
Author(s):  
S. Andronikou ◽  
C. Welman ◽  
E. Kader ◽  
J. Venter ◽  
T. Kilborn
Keyword(s):  
Head Injury ◽  
Head Injuries ◽  
Skull Fracture ◽  
Ct Scanning ◽  
Skull Fractures ◽  
Subdural Haemorrhage ◽  
Abnormal Finding ◽  
X Ray ◽  
Neurologically Normal ◽  
Air Pockets

Skull X-ray (SXR) has been, and still is, used in some institutions to detect skull fractures in paediatric head injuries. When no clinical/neurological indication for computed tomography (CT) scanning exists, the presence of a skull fracture may be used as an indication for this. This case report demonstrates an unusual SXR finding of oval lucencies in a neurologically normal child who had sustained a head injury. The subsequent CT scan demonstrated a subacute subdural haemorrhage with air pockets, highlighting the need to recognise intracranial air. The literature is reviewed regarding the usefulness of SXR in childhood head injury.

scholarly journals Evaluation of spirometry gated CT scan to measure lung volumes in emphysema patients

2021 ◽  
pp. 00492-2021
Author(s):  
Jens T Bakker ◽  
Karin Klooster ◽  
Jan Bouwman ◽  
Gert Jan Pelgrim ◽  
Rozemarijn Vliegenthart ◽  
...  
Keyword(s):  
Ct Scan ◽  
Pearson Correlation ◽  
Ct Scanning ◽  
Breath Hold ◽  
Strongly Correlated ◽  
Body Plethysmography ◽  
Lung Volumes ◽  
Copd Patients ◽  
The Mean ◽  
Correlation Factors

IntroductionIn emphysema patients, being evaluated for bronchoscopic lung volume reduction (BLVR), accurate measurement of lung volumes is important. Total Lung Capacity (TLC) and Residual Volume (RV) are commonly measured by body-plethysmography, but can also be derived from chest computed tomography (CT). Spirometry-gated CT scanning potentially improves the agreement of CT and body-plethysmography.ObjectiveTo compare lung volumes derived from spirometry-gated CT and “breath-hold-coached” CT to the reference standard: body-plethysmography.MethodsIn this single centre retrospective cohort study, emphysema patients, evaluated for BLVR, underwent body-plethysmography, inspiration (TLC) and expiration (RV) CT-scan with spirometer guidance (“gated group”) or with breath-hold-coaching (“non-gated group”). Quantitative analysis was used to calculate lung volumes from the CT.ResultsWe included 200 patients (age 62±8 years, FEV1 29.2±8.7%, TLC 7.50±1.46 L, RV 4.54±1.07 L). The mean CT-derived TLC was 280(±340)ml lower compared to body-plethysmography in the gated group (n=100), and 590(±430)ml lower for the non-gated group (n=100) (both p<0.001). The mean CT-derived RV was 300(±470)ml higher in the gated group and 700(±720)ml higher in the non-gated group (both p<0.001). Pearson correlation factors were 0.947 for TLC gated, 0.917 for TLC non-gated, 0.823 for RV gated, 0.693 for RV non-gated, 0.539 for %RV/TLC gated and 0.204 for %RV/TLC non-gated. The differences between the gated and non-gated CT results for TLC and RV were significant for all measurements (p<0.001).ConclusionIn severe COPD patients with emphysema, CT-derived lung volumes are strongly correlated to body-plethysmography lung volumes, and especially for RV, more accurate when using spirometry-gating.

Sign in / Sign up

Export Citation Format

Share Document