Based on the results of a new study, doctors should be reconsidering the way they treat patients who come to emergency rooms with mild traumatic brain injury (TBI).
It turns out that hospital MRIs may be better at predicting the long-term outcomes for those with mild TBI than CT scans, which are the standard technique for evaluating such cases in the emergency room, according to a clinical trial led by researchers at the University of California San Francisco (UCSF) and the San Francisco General Hospital and Trauma Center (SFGH).
UCSF issued a press release on the study.
http://www.ucsf.edu/news/2012/12/13326/mris-reveal-signs-brain-injuries-not-seen-ct-scans
The study was published this month in the journal Annals of Neurology, and was led by UCSF neuroradiologist Dr. Esther Yuh.
The trial followed 135 patients treated for mild TBI over the past two years at three urban hospitals with level-one trauma centers: SFGH, the University of Pittsburgh Medical Center and University Medical Center Brackenridge in Austin, Texas. The study was called the NIH-funded TRACK-TBI (Transforming Research and Clinical Knowledge in Traumatic Brain Injury).
All these patients had CT scans when they were first admitted, and all were given MRIs about a week later. According to the press release, “Most of them (99) had no detectable signs of injury on a CT scan, but more than a quarter (27/99) who had a ‘normal’ CT scan also had detectable spots on their MRI scans called ‘focal lesions,’ which are signs of microscopic bleeding in the brain.”
Noticing such lesions help doctors predict whether patients were likely to have persistent neurological problems. Roughly 15 percent of people who have mild TBI do suffer long-term neurological consequences, although right now doctors have no definitive way of predicting whether any one patient will or not.
“This work raises questions of how we’re currently managing patients via CT scan,” the study’s senior author Dr. Geoff Manley, chief of neurosurgery at SFGH and vice-chair of the Department of Neurological Surgery at UCSF, said in a statement. “Having a normal CT scan doesn’t, in fact, say you’re normal.”
Most people with mild TBI recover, but about one in six develop persistent, sometimes permanent, disability, according to the press release. But there’s no way to predict which patients are will have a long-term impact from their TBI.
The new study, according to Manley, could be “an important step toward defining a more quantitative way of assessing patients with mild traumatic brain injuries and developing more precision medical tools to detect, monitor and treat them.”
Physicians could closely track patients they knew were at risk of greater disabilities.
“Being able to identify patients at risk of long-term consequences would also speed the development of new therapeutics because it would allow doctors to identify patients who would benefit the most from treatment and improve their ability to test potential new drugs in clinical trials,” the press release said.
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