Chaudhari Pradip P, Pineda Jose A, Bachur Richard G, Khemani Robinder G
Division of Emergency and Transport Medicine Children's Hospital Los Angeles Los Angeles California USA.
Keck School of Medicine of the University of Southern California Los Angeles California USA.
J Am Coll Emerg Physicians Open. 2021 Mar 6;2(2):e12400. doi: 10.1002/emp2.12400. eCollection 2021 Apr.
We aimed to determine trends and institutional variation in repeat neuroimaging in children with traumatic intracranial hemorrhage and to identify factors associated with neuroimaging modality (subsequent magnetic resonance imaging [MRI] vs computed tomography [CT]).
We conducted a retrospective cross-sectional study of 35 hospitals in the Pediatric Health Information System database. We included children <18 years of age hospitalized from 2010-2019 with intracranial hemorrhage and who underwent a brain CT. We calculated repeat neuroimaging rates by modality and used regression analyses to examine temporal trends. We used hierarchical logistic regression to identify factors associated with subsequent MRI versus repeat CT, controlling for hospital.
We identified 12,714 children with intracranial hemorrhage, of which 5072 with repeat neuroimaging were studied. Of the 5072 children with repeat neuroimaging, repeat CT was performed in 67.6% (n = 3429) and subsequent MRI in 32.4% (n = 1643). Overall repeat neuroimaging with either a CT or MRI remained similar from 2010-2019 ( = 0.431); however, repeat CT scans significantly decreased ( = 0.001); whereas, MRIs significantly increased ( < 0.001). Repeat neuroimaging by hospital ranged from 20%-80%. After controlling for institution, subsequent MRI was more likely to be used in younger children and children who did not receive hyperosmotic agents, neurosurgical interventions, or intensive care unit admission (all -values <0.001).
We found that repeat neuroimaging rates for children with intracranial hemorrhage vary substantially by institution. We also found that although MRI was increasingly used to re-image these children, overall repeat neuroimaging rates (CT or MRI) have not decreased over the past decade. Future work to implement optimal utilization of neuroimaging in these children is needed.
我们旨在确定创伤性颅内出血患儿重复神经影像学检查的趋势和机构差异，并确定与神经影像学检查方式（后续磁共振成像[MRI]与计算机断层扫描[CT]）相关的因素。
我们对儿科健康信息系统数据库中的35家医院进行了一项回顾性横断面研究。我们纳入了2010年至2019年因颅内出血住院且接受过脑部CT检查的18岁以下儿童。我们按检查方式计算重复神经影像学检查率，并使用回归分析来研究时间趋势。我们使用分层逻辑回归来确定与后续MRI与重复CT相关的因素，并对医院进行控制。
我们确定了12714例颅内出血患儿，其中5072例接受了重复神经影像学检查。在5072例接受重复神经影像学检查的患儿中，67.6%（n = 3429）进行了重复CT检查，32.4%（n = 1643）进行了后续MRI检查。从2010年到2019年，总体上使用CT或MRI进行的重复神经影像学检查保持相似（ = 0.431）；然而，重复CT扫描显著减少（ = 0.001）；而MRI显著增加（ < 0.001）。各医院的重复神经影像学检查率在20%至80%之间。在控制机构因素后，后续MRI更有可能用于年龄较小的儿童以及未接受高渗药物、神经外科干预或入住重症监护病房的儿童（所有 -值<0.001）。
我们发现颅内出血患儿的重复神经影像学检查率在不同机构之间存在很大差异。我们还发现，尽管MRI越来越多地用于对这些患儿进行再次成像，但在过去十年中，总体重复神经影像学检查率（CT或MRI）并未下降。需要开展未来工作，以实现对这些患儿神经影像学检查的最佳利用。
