RESOURCE UTILIZATION IN TRAUMATIC BRAIN INJURY - THE ROLE OF MAGNETIC-RESONANCE-IMAGING

Cerebral CT scanning is routine in the acute evaluation of traumatic b rain injury (TBI) patients. MRI has been reported to identify cerebral lesions better than CT scan. The purpose of this study was to determi ne whether MRI influenced the acute diagnosis and management of TBI pa tients. A retrospective medical records review was performed on all TB I patients undergoing cerebral CT scan and MRI admitted to a regional trauma center during a 2-year period. Patient data collected included demography, extent of TBI, CT scan and MRT use, and therapeutic interv entions. Forty TBI patients (initial Glascow Coma Scale, 8.8 +/- 0.7) underwent 79 CT scans and 40 MRIs. Time to initial CT scan was 6.3 +/- 4.3 hours and time to MRI was 2.9 +/- 3.1 days. Nine patients (22.5%) had injuries on CT scan but not on MRI, most commonly skull fractures or small subarachnoid hemorrhages. Twenty-four patients (60%) had inj uries on MRI but not on CT scan, most commonly corpus callosum shear i njuries. There were two cases of child abuse and both had injuries of varying ages identified by MRI, but not CT. All injuries requiring a t herapeutic intervention or change in management were identified by CT scan. Magnetic resonance angiography identified one patient with a tra umatic internal carotid artery thrombosis. The performance of MRI resu lted in additional charges of $75,640 or $3,152/patient identified wit h a new lesion. Although MRI identifies lesions not evident on CT scan , MRI does not alter management plans and is of limited value in the a cute management: of TBI, MRI may be of medicolegal benefit in cases of child abuse.