Neuroimaging may not be necessary for all children with sports-related concussion.
Clinical neuroimaging studies are normal in the majority of pediatric patients with sports-related concussion (SRC), according to a study published in the Journal of Neurosurgery: Pediatrics.
Researchers from the Canada North Concussion Network, in Winnipeg, Canada, performed a retrospective review to summarize the results of clinical neuroimaging studies performed on 151 children and adolescents with SRC who were referred to a multidisciplinary pediatric concussion program.
The patients had sustained SRCs, diagnosed and followed up by a single neurosurgeon specializing in concussion spectrum disorders, during competitive sports activities such as hockey, soccer, and baseball. The patient mean age was 14 and 59% of the patients were female.
A total of 36 of the 151 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Computed tomography (CT) scans were obtained prior to referral in 23 patients and after consultation in one patient. Magnetic resonance images (MRIs) were obtained after referral to the concussion program in 15 patients and before referral in one patient.
|79% had normal findings||75% had normal findings|
|1 patient - arachnoid cyst||1 patient - intraparenchymal hemorrhage and sylvian fissure arachnoid cyst|
|2 patients - skull fracture||1 patient – nonhemorrhagic contusion|
|1 patient - suspected intracranial hemorrhage||1 patient - demyelinating disease|
|1 patient - suspected hemorrhage into an arachnoid cyst||1 patient - posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes|
The researchers concluded that results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, they do have their place when there are worrisome symptoms or there is an abnormal inconclusive CT scan. Magnetic resonance imaging "should also be considered in pediatric patients with persistent symptoms for which the definition is unclear,” they wrote.
"Methodologically, this study does not tell us which patients are more likely to demonstrate traumatic abnormalities on clinical neuroimaging, including magnetic resonance imaging,” co-author Michael J. Ellis, MD, said in a release. “This question will be addressed by a prospective clinical study that is currently underway at our institution."