Morgan Clinton D, Zuckerman Scott L, King Lauren E, Beaird Susan E, Sills Allen K, Solomon Gary S
Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA.
Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA.
Childs Nerv Syst. 2015 Dec;31(12):2305-9. doi: 10.1007/s00381-015-2916-y. Epub 2015 Sep 29.
Approximately 90% of concussions are transient, with symptoms resolving within 10-14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS.
We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected.
Of 52 patients with PCS, 23/52 (44%) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3%), 1/8 CTs (13%), and 0/5 x-rays (0%) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI.
In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase.
约90%的脑震荡是短暂性的，症状在10 - 14天内缓解。然而，少数患者在受伤数月后仍有症状，这种情况称为脑震荡后综合征（PCS）。这些患者的治疗可能具有挑战性。我们研究的目的是评估在一组患有PCS的青少年中，受伤两周或更长时间后进行神经影像学检查的效用和成本效益。
我们对52例伤后3个月仍有持续性脑震荡后症状的儿科患者进行了回顾性研究。我们收集了人口统计学资料以及脑震荡后2周以上获得的神经影像学结果。脑震荡后前2周内进行的神经影像学检查被排除，除非是为了确定再次成像的比率。收集了描述性统计数据和相应的成本数据。
在52例PCS患者中，23/52（44%）在初次受伤至少2周后进行了神经影像学检查，总共进行了32项诊断性研究。总体而言，1/19例MRI（5.3%）、1/8例CT（13%）和0/5例X线检查（0%）发现了显著阳性结果，这些结果均未改变临床管理。这52例儿科患者的慢性期神经影像学检查估计总费用为129,025美元。我们估计，通过头部CT发现一个阳性结果的成本为21,000美元，通过脑部MRI发现一个阳性结果的成本为104,500美元。
在这组儿科PCS患者中，几乎一半的研究样本在慢性期（定义为脑震荡后超过2周）进行了脑成像检查，诊断率低，成本效益差。基于这些结果，对于有长期脑震荡后症状的儿科患者，门诊管理中急性期后很少应包括重复神经影像学检查。
