Is MRI imaging an alternative to computed tomography for head injuries in children and adolescents in acute situations? An analysis of the TraumaRegister DGU ®

Introduction Although head injuries are one of the most common causes of emergency room admissions in childhood and adolescence, severe traumatic brain injuries are rare. For acute diagnosis in the emergency department, (cranial) computed tomography (CT or cCT) is the gold standard, but magnetic resonance imaging (MRI) has become an increasingly valid alternative recently due to optimized protocols. This also applies to the recommendations in the current guidelines. The aim of this study was to use the national database of the TraumaRegister DGU ^® to determine the current status of MRI diagnostics for pediatric traumatic brain injury (TBI) in European trauma centers. Material and method The TraumaRegister DGU ^® (TR-DGU) data sets were analyzed from 2015 to 2022. All children up to the age of 15 with a relevant injury (AIS 2+) and primary admission to a European trauma center who were registered in the TraumaRegister DGU ^® between 2015 and 2022 were included. In a further step, relevant predictors were determined by multivariate analysis. Results A total of 5000 children were included, 205 MRI images (4.1%) and 4002 CT images (79.8%) were documented. MRI diagnosis was performed more frequently in the 0-to-1-year age group (5.2%) than in the 14-to-17-year age group (3.5%). In conjunction with initial CT imaging, the median total time in the emergency room was 59 min, with a median time to CT of 19 min. When carrying out MRI imaging, the average total time in the emergency room was 85 min, with a median time to MRI of 49 min. Of the prehospital-intubated children (mean ISS 26.3), 91.6% had a CT scan in the acute diagnostic phase and 2.4% an MRI scan. The strongest positive predictor for MRI imaging was a concomitant cervical spine injury (OR=3.63, p<0.001) and the strongest negative predictor was prehospital intubation (OR = 0.54, p=0.007). Discussion CT imaging remains the gold standard in national comparison especially for severely injured children, partly due to its faster and wider availability after the patient arrives in the emergency room. However, in addition to radiation hygiene, the superior assessibility of the cervical spine in case of concomitant (ligamentous/soft tissue) injuries also speaks in favor of MRI imaging, particularly in young patients. If the necessary structural procedures and accessibility are at hand and when the patient's condition permits, MRI diagnostics should be considered as an alternative to CT imaging for childhood head injuries. The two procedures are nearly equivalent in terms of sensitivity.