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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.