Trends in Early MRI Utilization in Critically Ill Children with Severe TBI: a Single Center Experience, 2010–2021 (P14-9.012)

Abstract

<h3>Objective:</h3> To characterize acquisition and timing of early magnetic resonance imaging (MRI) in children hospitalized with severe traumatic brain injury (TBI). <h3>Background:</h3> 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. <h3>Design/Methods:</h3> 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] &lt; 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. <h3>Results:</h3> 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&lt;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). <h3>Conclusions:</h3> 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. <b>Disclosure:</b> Dr. Janas has nothing to disclose. Mrs. Campbell has nothing to disclose. Dr. Ruzas has nothing to disclose. Dr. Messer has nothing to disclose. Nicholas Stence has nothing to disclose. Dr. Samples has nothing to disclose. The institution of Dr. Wyrwa has received research support from Foundation for Physical Medicine and Rehabilitation. 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. The institution of Dr. Maddux has received research support from NIH/NICHD. The institution of Dr. Maddux has received research support from CDC.