Brain imaging in mild traumatic brain injury and neuropsychiatric disorders a quantitative MRI study /

by Hofman, Paulus Albertus

Objectives-Head injury is a common event. Most patients sustain a mild traumatic brain injury (mTBI), and management depends on the risk of an intracranial haemorrhage (ICH). The value of a plain skull X-ray as screening tool for ICH is controversial. The aim of this meta-analysis is to estimate and explain differences in reported sensitivity and specificity of the finding of a skull fracture for the diagnosis of ICH, in order to assess the value of the plain skull X-ray in the work-up of mTBI patients, and to estimate the prevalence of ICH in these patients. Method-After a systematic literature search 20 studies were selected that reported data on the prevalence of ICH after mTBI and/or data on the diagnostic value of skull fracture for the diagnosis ICH. The mean prevalence of ICH weighted for the sample size was determined. The sensitivity and specificity of different studies were combined using a summary receiver operator characteristic curve. Correlation analysis was used to determine factors that could explain the reported differences between studies. Results-The weighted mean prevalence of ICH after mTBI is 0.083. The potential for verification bias and the percentage of patients who had suffered loss of consciousness or post-traumatic amnesia were the most significant factors explaining inter-study differences in sensitivity and specificity. Based on studies wherein at least 50% of patients had a computed tomography study of the brain, the estimated sensitivity of an X-ray finding of skull fracture for the diagnosis of ICH is 0.38 with a corresponding specificity of 0.95. Conclusion-The plain skull X-ray is of little value in the initial assessment of mTBI patients. 34