Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma

Johanna Ludwig; Peter Heumann; Denis Gümbel; Ulrike Rechenberg; Leonie Goelz; Sven Mutze; Axel Ekkernkamp; Sinan Bakir

doi:10.1007/s00068-021-01736-7

Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma

Eur J Trauma Emerg Surg. 2022 Jun;48(3):2165-2172. doi: 10.1007/s00068-021-01736-7. Epub 2021 Jul 19.

Authors

Johanna Ludwig^{1

2}, Peter Heumann³, Denis Gümbel^{3

4}, Ulrike Rechenberg³, Leonie Goelz^{5

6}, Sven Mutze^{5

6}, Axel Ekkernkamp^{3

4}, Sinan Bakir^{3

4}

Affiliations

¹ Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Trauma Hospital Berlin, Warener Straße 7, 12683, Berlin, Germany. mail@johannaludwig.com.
² Kellogg College, University Oxford, Oxford, UK. mail@johannaludwig.com.
³ Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Trauma Hospital Berlin, Warener Straße 7, 12683, Berlin, Germany.
⁴ Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
⁵ Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.
⁶ Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.

Abstract

Purpose: Severe accidents are the leading cause of long-term impairment and death in children. A common diagnostic procedure for children exposed to high-injury trauma is full-body contrast-enhanced CT (fbCT). However, the number of fbCT without detected injuries is relevant. In 2007, full-body MRI (fbMRI) was implemented as a diagnostic approach for children sustaining high-energy trauma. The aim of this cross-sectional retrospective study was to analyze fbMRI as a diagnostic tool for children after high-energy trauma focusing on feasibility, radiological findings, and limitations.

Methods: Diagnostics using fbMRI (from apex of the head to the pelvis) was performed if a child was stable and suffered a high-energy trauma in a Level I Trauma Center in Germany. 105 fbMRIs in patients exposed to high-energy trauma aged ≤ 16 years were performed between January 2007 and December 2018. Four fbMRIs were excluded as conducted for reasons other than trauma. Time between arrival in the emergency department and fbMRI, additional diagnostic procedures, injuries, and non-trauma related pathologies were analyzed.

Results: Mean time between arrival in the emergency department and fbMRI was 71 min (± SD 132 min). Two scans were discontinued and changed to a faster diagnostic procedure. 45% of children had additional X-rays and 11% CT scans. The MRIs showed intracranial abnormalities in 27%, extremities injuries in 26%, spinal injuries in 18%, pelvic, and thoracic injuries in 7% of the cases.

Conclusion: Overall fbMRI is a diagnostic alternative for hemodynamically stable, conscious children after high-energy trauma with the advantages of a radiation-free technique. However, MRI diagnostics take longer than CT scans. Prospective studies will be needed to identify the limiting factors of fbMRIs as primary diagnostic procedure compared to CT scans.

Trial registration: German Clinical Trials Register (DRKS; DRKS00017015).

Level of evidence: Case series, level of evidence V.

Keywords: Children; Diagnostic; MRI; Trauma.

Publication types

Clinical Trial

MeSH terms

Child
Cross-Sectional Studies
Humans
Magnetic Resonance Imaging*
Prospective Studies
Retrospective Studies
Trauma Centers*

Associated data

DRKS/DRKS00017015