Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2022

Open Access 19-07-2021 | Original Article

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

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

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

Login to get access

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.
Literature
1.
2.
Buschmann C, Kühne CA, Lösch C, Nast-Kolb D, Ruchholtz S. Major trauma with multiple injuries in German children: a retrospective review. J Pediatr Orthop. 2008;28:1–5.PubMed
3.
van As AB, Manganyi R, Brooks A. Treatment of thoracic trauma in children: literature review, red cross war memorial children’s hospital data analysis, and guidelines for management. Eur J Pediatr Surg. 2013;23:434–43.PubMed
4.
Bouillon B, Pieper D (2016) Kurzversion der S3-leitlinie polytrauma/schwerverletzten-behandlung. 36. Deutsche Gesellschaft für Unfallchirurgie, Berlin
5.
Richardson MC, Hollman AS, Davis CF. Comparison of computed tomography and ultrasonographic imaging in the assessment of blunt abdominal trauma in children. BJS. 1997;84:1144–6.
6.
Drexel S, Azarow K, Jafri MA. Abdominal trauma evaluation for the pediatric surgeon. Surg Clin North Am. 2017;97:59–74.PubMed
7.
Schunk JE, Schutzman SA. Pediatric head injury. Pediatr Rev. 2012;33:398–410 (quiz 410–1).PubMed
8.
Baker N, Woolridge D. Emerging concepts in pediatric emergency radiology. Pediatr Clin North Am. 2013;60:1139–51.PubMed
9.
10.
11.
Holmes JF, Lillis K, Monroe D, Borgialli D, Kerrey BT, Mahajan P, et al. Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013;62:107-116.e2.PubMed
12.
Hom J. The risk of intra-abdominal injuries in pediatric patients with stable blunt abdominal trauma and negative abdominal computed tomography. Acad Emerg Med. 2010;17:469–75.PubMed
13.
14.
George MP, Bixby S. Frequently missed fractures in pediatric trauma: a pictorial review of plain film radiography. Radiol Clin Elsevier. 2019;57:843–55.
15.
16.
Banaste N, Caurier B, Bratan F, Bergerot J-F, Thomson V, Millet I. Whole-body CT in patients with multiple traumas: factors leading to missed injury. Radiol Radiol Soc North Am. 2018;289:374–83.
17.
Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380:499–505.PubMedPubMedCentral
18.
Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ British Med J Publ Group. 2013;346:f2360.
19.
Brunetti MA, Mahesh M, Nabaweesi R, Locke P, Ziegfeld S, Brown R. Diagnostic radiation exposure in pediatric trauma patients. J Trauma. 2011;70:E24-28.
20.
Raelson CA, Kanal KM, Vavilala MS, Rivara FP, Kim LJ, Stewart BK, et al. Radiation dose and excess risk of cancer in children undergoing neuroangiography. AJR Am J Roentgenol. 2009;193:1621–8.PubMed
21.
Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167:700–7.PubMedPubMedCentral
22.
Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176:289–96.PubMed
23.
Stengel D, Mutze S, Güthoff C, Weigeldt M, von Kottwitz K, Runge D, et al. Association of low-dose whole-body computed tomography with missed injury diagnoses and radiation exposure in patients with blunt multiple trauma. JAMA Surg. 2020;155:224–32.PubMedPubMedCentral
24.
Wu D, Wang G, Bian B, Liu Z, Li D. Benefits of low-dose CT scan of head for patients with intracranial hemorrhage. Dose Response. 2020;19:1559325820909778.PubMed
25.
Anderson S. Trauma and emergency radiology, an issue of radiologic clinics of North America. Philadelphia: Elsevier Health Sciences; 2019. (EBook).
26.
Jaffe D, Wesson D. Emergency management of blunt trauma in children. N Engl J Med. 1991;324:1477–82.PubMed
27.
Miele V, Giampietro ID, Ianniello S, Pinto F, Trinci M. Diagnostic imaging in pediatric polytrauma management. Radiol med. 2015;120:33–49.PubMed
28.
29.
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. New Engl J Med Massachusetts Med Soc. 2007;357:2277–84.
30.
Nikkilä A, Raitanen J, Lohi O, Auvinen A. Radiation exposure from computerized tomography and risk of childhood leukemia: finnish register-based case-control study of childhood leukemia (FRECCLE). Haematologica. 2018;103:1873–80.PubMedPubMedCentral
31.
Sheppard JP, Nguyen T, Alkhalid Y, Beckett JS, Salamon N, Yang I. Risk of brain tumor induction from pediatric head CT procedures: a systematic literature review. Brain Tumor Res Treat. 2018;6:1–7.PubMedPubMedCentral
32.
Mueller DL, Hatab M, Al-Senan R, Cohn SM, Corneille MG, Dent DL, et al. Pediatric radiation exposure during the initial evaluation for blunt trauma. J Trauma. 2011;70:724–31.PubMed
33.
The Royal College of Radiologists. Paediatric trauma protocols. London: The Royal College of Radiologists; 2014.
34.
Sodhi KS, Krishna S, Saxena AK, Sinha A, Khandelwal N, Lee EY. Clinical application of “Justification” and “Optimization” principle of ALARA in pediatric CT imaging: ‘How many children can be protected from unnecessary radiation?’ Eur J Radiol. 2015;84:1752–7.PubMed
35.
Brody AS, Frush DP, Huda W, Brent RL. American academy of pediatrics section on radiology. Radiation risk to children from computed tomography. Pediatrics. 2007;120:677–82.PubMed
36.
Habre W, Disma N, Virag K, Becke K, Hansen TG, Jöhr M, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med Elsevier. 2017;5:412–25.
37.
Strøm C, Lundstrøm LH, Afshari A, Lohse N. Characteristics of children aged 2–17 years undergoing anaesthesia in Danish hospitals 2005–2015: a national observational study. Anaesthesia. 2018;73:1321–36.PubMed
38.
Enderson BL, Reath DB, Meadors J, Dallas W, DeBoo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. J Trauma. 1990;30:666–9 (discussion 669–670).PubMed
39.
Heinrich SD, Gallagher D, Harris M, Nadell JM. Undiagnosed fractures in severely injured children and young adults. Identification with technetium imaging. J Bone Joint Surg Am. 1994;76:561–72.PubMed
40.
Jaimes C, Jimenez M, Shabshin N, Laor T, Jaramillo D. Taking the stress out of evaluating stress injuries in children. Radiographics. 2012;32:537–55.PubMed
41.
Randsborg P-H, Sivertsen EA. Classification of distal radius fractures in children: good inter- and intraobserver reliability, which improves with clinical experience. BMC Musculoskelet Disord. 2012;13:6.PubMedPubMedCentral
42.
Cohen AR, Caruso P, Duhaime A-C, Klig JE. Feasibility of “rapid” magnetic resonance imaging in pediatric acute head injury. Am J Emerg Med. 2015;33:887–90.PubMed
43.
Lumba-Brown A, Lee MO, Brown I, Cornwell J, Dannenberg B, Fang A, et al. Emergency department implementation of abbreviated magnetic resonance imaging for pediatric traumatic brain injury. J Am Coll Emerg Phys Open. 2020;1:994–9.
44.
Vane DW, Shackford SR. Epidemiology of rural traumatic death in children: a population-based study. J Trauma. 1995;38:867–70.PubMed
45.
Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA Am Med Assoc. 2004;292:1823–30.
46.
Romanova AL, Nemeth AJ, Berman MD, Guth JC, Liotta EM, Naidech AM, et al. MRI versus CT for identification and quantification of intraventricular hemorrhage. J Stroke Cerebrovasc Dis. 2014;23:2036–40.PubMedPubMedCentral
47.
Ramirez J, Thundiyil J, Cramm-Morgan KJ, Papa L, Dobleman C, Giordano P. 53: MRI utilization trends in a large tertiary care pediatric emergency department. Ann Emerg Med. 2010;3(Supplement):S18–9.
48.
Ahn S, Kim WY, Lim KS, Ryoo SM, Sohn CH, Seo DW, et al. Advanced radiology utilization in a tertiary care emergency department from 2001 to 2010. PLoS ONE. 2014;9:e112650.PubMedPubMedCentral
49.
Scheinfeld MH, Moon J-Y, Fagan MJ, Davoudzadeh R, Wang D, Taragin BH. MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years. Pediatr Radiol. 2017;47:327–32.PubMed
Metadata
Title
Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma
Authors
Johanna Ludwig
Peter Heumann
Denis Gümbel
Ulrike Rechenberg
Leonie Goelz
Sven Mutze
Axel Ekkernkamp
Sinan Bakir
Publication date
19-07-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01736-7

Other articles of this Issue 3/2022

European Journal of Trauma and Emergency Surgery 3/2022 Go to the issue

Original Article

Management of subtrochanteric femur fractures: is open reduction associated with poor outcomes?

Original Article

Short-term outcome of fragility fractures of the pelvis in the elderly treated with screw osteosynthesis and external fixator

Original Article

Standardized porcine unilateral femoral nailing is associated with changes in PMN activation status, rather than aberrant systemic PMN prevalence

Original Article

On the black slope: analysis of the course of a blunt renal trauma collective in a winter sports region

Original Article

Pelvic fractures in severely injured elderly: a double-adjustment propensity score matched analysis from a level I trauma center

Original Article

Differences of hemiarthroplasty and total hip replacement in orthogeriatric treated elderly patients: a retrospective analysis of the Registry for Geriatric Trauma DGU®