Neuroimaging of concussion patients in an outpatient clinic

Abstract

Objective To evaluate the use of neuroimaging safety, diagnoses, and potential treatment of patients with concussion. Methods This retrospective study took advantage of a concussion database to analyze neuroimaging in concussion patients of all ages. Details of neuroimaging orders were tracked and categorized as hospital emergency rooms, primary care physicians, neurologists at DENT, or by other specialists. Neuroimaging consisted of MRI and/or CT scans, which were classified as normal or abnormal. AbnormalMRI scans consisted of white matter changes, brain hemorrhage, chiari malformation, cyst arachnoid, hydrocephalus, incidental unrelated finding, or a developmental venous anomaly. Abnormal was further defined as abnormal due to head injury, unrelated to the concussion but unlikely to prolong recovery time, or unrelated to the concussion but may prolong recovery time. Results Among the 835 diagnosed with concussion, 715 (86%) patients ages 1-78 had neuroimaging completed (615 MRI and 422 CT). Among these patients 401 (95%) had a CT order prior to coming to Dent, 319 (80%) from emergency rooms, 64 (16%) from primary care physicians, and 18 (4%) from other physician specialists. The rate of ordering an MRI was 46% greater than the rate of ordering a CT scans, while the rate of discovering an abnormality within MRI scans was 3 times greater than CTs (24.3% vs 7.8%). Conclusions There exists a remarkable discrepancy between the rate of ordering neuroimaging in concussion patients (46% more MRI vs CT orders) and the rate at which neuroimaging in these patients discovered brain abnormalities (x2.11 more in MRI vs CT reads). We acknowledge that improvement is required in the length of time in the MRI scanner and cost of MRI technology. However, additional consideration is required in abnormality detection effectiveness, cost efficiency, and radiation safety in balancing the use of MRI and CT technology. Disclosures: Dr. McVige has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen, Avinir, Teva, and Supernus. Dr. Shukri has nothing to disclose. Dr. Bargnes has nothing to disclose. Dr. Lillis has nothing to disclose.