Neuroimaging for mild traumatic brain injury in children: cross-sectional study using national claims data

• Published in: Pediatric radiology 2023-05, Vol.53 (6), p.1163-1170
• Main Authors: Waltzman, Dana, Miller, Gabrielle F., Patel, Nimesh, Sarmiento, Kelly, Breiding, Matthew, Lumba-Brown, Angela
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Brain; Brain Concussion - diagnostic imaging; Brain Concussion - epidemiology; Child; Children; Cross-Sectional Studies; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Head injuries; Humans; Imaging; Injury prevention; Magnetic Resonance Imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Neuroimaging; Neuroradiology; Nuclear Medicine; Oncology; Original Article; Pediatrics; Population (statistical); Radiology; Regression analysis; Regression models; Rural populations; Statistical analysis; Traumatic brain injury; Ultrasound; Young Adult; Young adults
• ISSN: 1432-1998; 0301-0449; 1432-1998
• DOI: 10.1007/s00247-023-05633-6

Background Current guidelines recommend healthcare professionals avoid routine use of neuroimaging for diagnosing mild traumatic brain injury (mTBI). Objective This study aimed to examine current use of CT and MRI among children and young adult patients with mTBI and factors that increase likelihood of neuroimaging in this population. Materials and methods Data were analyzed using the 2019 MarketScan commercial claims and encounters database for the commercially insured population for both inpatient and outpatient claims. Descriptive statistics and logistic regression models for patients  ≤24 years of age who received an ICD-10-CM code indicative of a possible mTBI were analyzed. Results Neuroimaging was performed in 16.9% (CT; 95% CI=16.7–17.1) and 0.9% (MRI; 95% CI=0.8–0.9) of mTBI outpatient visits (including emergency department visits) among children (≤18 years old). Neuroimaging was performed in a higher percentage of outpatient visits for patients 19–24 years old (CT=47.1% [95% CI=46.5–47.6] and MRI=1.7% [95% CI=1.5–1.8]), and children aged 15–18 years old (CT=20.9% [95% CI=20.5–21.2] and MRI=1.4% [95% CI=1.3–1.5]). Outpatient visits for males were 1.22 (95% CI=1.10–1.25) times more likely to include CT compared to females, while there were no differences by sex for MRI or among inpatient stays. Urban residents, as compared to rural, were less likely to get CT in outpatient settings (adjusted odds ratio [aOR]=0.55, 95% CI=0.53–0.57). Rural residents demonstrated a larger proportion of inpatient admissions that had a CT. Conclusions Despite recommendations to avoid routine use of neuroimaging for mTBI, neuroimaging remained common practice in 2019.