343 - Increasing Utilization of Quick Brain Magnetic Resonance Imaging for Evaluation of Patients with Mild Traumatic Brain Injury

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 343
Publication Number: 343.209

Beech S. Burns, Oregon Health & Science University, Portland, OR USA, OR, United States; Walker Andrews, Oregon Health & Science University School of Medicine, Portland, OR, United States; Nelly Nouboussi, Oregon Health & Science University School of Medicine, Portland, OR, United States; Nathan R. Selden, Oregon Health & Science University School of Medicine, Portland, OR, United States; Mubeen Jafri, Oregon Health & Science University School of Medicine, Portland, OR, United States; David R. Pettersson, Oregon Health & Science University, Portland, OR, United States; Kenneth A. DeVane, Oregon Health and Science University, Portland, OR, United States; Amber Lin, Oregon Health & Science University School of Medicine, Portland, OR, United States; David C. Sheridan, Oregon Health & Science University School of Medicine, Portland, OR, United States

Presenting Author(s)

Nelly Nouboussi, BS

Medical student
Oregon Health & Science University School of Medicine
Portland, Oregon, United States

Co-Author(s)

Beech S. Burns, MD, MCR (he/him/his)

Associate Professor
Oregon Health & Science University
Portland, OR USA, Oregon, United States

Background: Head trauma is a common reason for children to visit the emergency department (ED). Head computed tomography (CT) has long been the gold standard for detecting clinically important traumatic brain injury (ciTBI) but involves exposure to ionizing radiation that increases the risk of developing malignancy in children. Several recent studies have demonstrated that quick brain MRI (qbMRI) has comparable sensitivity and specificity to CT in evaluating patients for ciTBI.

Objective: We aimed to increase utilization of qbMRI to greater than 80% for eligible patients in the pediatric emergency department (ED) over a 12-month period.

Design/Methods: We conducted a quality improvement initiative through a series of interventions including multidisciplinary guideline development, physician and nurse education regarding algorithm implementation, electronic health record integration, and monthly audit of mild TBI cases coupled with provider feedback around imaging choice. We included patients with mild TBI who underwent neuroimaging, excluding patients with concern for non-accidental trauma, those requiring CT of another anatomical area, and those deemed clinically unstable. Balancing measures included proportion of all patients with mild TBI who underwent neuroimaging of any kind, proportion of patients requiring sedation, and mean ED length of stay (LOS).

Results: Comparing the pre-intervention (January to December 2020) to the post-intervention periods (January to December 2021), we successfully increased utilization of QB MRI from 47.2 to 85.1% (p= < 0.001) of eligible patients. Overall neuroimaging rates did increase slightly after the intervention (20.0 vs 25.3%, p=0.047), there was no difference in the need for anxiolysis (12.2 vs 7.4%, p=0.301), and ED LOS was marginally longer (1.4 vs 1.9 hours, p= < 0.001). There was no difference in the percentage of patients with ciTBI in the two periods (0.3%) and no patient returned within 1 week for ciTBI in either period.

Conclusion(s): Quick brain MRI can serve safely and effectively as the primary imaging modality for evaluation of mild TBI in the pediatric ED with only small increases in overall neuroimaging rates and ED LOS.