UMEM Educational Pearls

Category: Orthopedics

Title: MRI for Concussion Testing in the ED

Keywords: mTBI, concussion, MRI (PubMed Search)

Posted: 5/9/2020 by Brian Corwell, MD (Updated: 3/5/2024)
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MRI for Concussion Testing in the ED

 

The increased sensitivity of MRI may have a role in detecting more subtle intracranial injuries.

135 patients with mild TBI were prospectively evaluated for acute head injury in emergency departments of 3 LEVEL I trauma. 

27% of these patients with a normal initial head CT had an abnormal brain MRI including contusions and microhemorrhages. A greater number of these subtle findings was associated with neuropsychological defects on both short-term memory function and with poorer 3 month cognitive outcomes. Inherent difficulties of access, actionable results and reimbursement issues prevent application of MRI for concussion evaluation in the ED.

Note: Mild TBI defined as GCS 13-15 is not the same as sport or activity related concussion which I consider to be GCS 14-15.

 

Take home: There is currently no role for MRI in the acute evaluation of concussion in the ED.

 

 

References

1) Yuh et al., 2013. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann Neurol.

2) Huang et al., 2015. Susceptibility weighted MRI in mild traumatic brain injury. Neurology.