Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging

• Published in: Child's nervous system 2015-12, Vol.31 (12), p.2305-2309
• Main Authors: Morgan, Clinton D., Zuckerman, Scott L., King, Lauren E., Beaird, Susan E., Sills, Allen K., Solomon, Gary S.
• Format: Article
• Language: English
• Subjects: Adolescent; Brain - diagnostic imaging; Brain - pathology; Child; Child, Preschool; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Original Paper; Post-Concussion Syndrome - diagnosis; Retrospective Studies; Tomography, X-Ray Computed
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-015-2916-y

Purpose Approximately 90% of concussions are transient, with symptoms resolving within 10–14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase.