Magnetic Resonance Imaging Reveals an Important Role for Brain Ischemia Across Injury Severity in Abusive Head Trauma in Infants and Young Children.

Abstract

To determine the prevalence and associations of ischemia with injury severity and discharge outcomes in pediatric traumatic brain injury (TBI). All imaging interpretations (head computed tomography [CT] and brain magnetic resonance imaging [MRI]) during hospitalization were reviewed in a retrospective cohort of children aged < 3 years admitted with TBI to our pediatric intensive care unit from 2011-2024. Initial TBI severity was defined by presenting Glasgow Coma Scale score as mild 13-15, moderate 9-12, or severe 3-8. Impairment was defined as an increase in Functional Status Score > 1 (preinjury to discharge). Data analysis used nonparametric tests. Of 946 children, 560/946 (59%) had only head CT, 52/946 (5%) had only brain MRI, and 334/946 (35%) had both. Ischemia was identified in 107/946 (14%) children (95 by MRI and 12 by CT) with 56 (52%) and 13 (12%) children with severe and moderate TBI, respectively. In mild TBI, ischemia was present in 35/232 (15%) cases of abusive head trauma (AHT) vs only 3/479 (0.3%) children with accidental TBI (P < .001). Children with ischemia had more impairment at discharge (80/107 [75%] vs 121/839 [14%], P < .001). Ischemia was associated with AHT and unfavorable outcomes. Ischemia in mild AHT suggests an unrecognized injury. Further work is needed to determine whether early MRI may be an important tool to detect ischemia and AHT.