title: Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging.
abstract: OBJECTIVE
  Approximately 90% of concussions are transient, with symptoms resolving within 10-14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS.
  
  
  METHODS
  We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected.
  
  
  RESULTS
  Of 52 patients with PCS, 23/52 (44%) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3%), 1/8 CTs (13%), and 0/5 x-rays (0%) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI.
  
  
  CONCLUSIONS
  In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase.
authors.affiliation: Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA.
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Morgan
authors.affiliation: Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA. scott.zuckerman@vanderbilt.edu.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: King
authors.affiliation: Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Beaird
authors.affiliation: Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA.
authors.forename: Allen K
authors.initials: AK
authors.lastname: Sills
authors.affiliation: Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Solomon
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D038223:Post-Concussion Syndrome / Q000175:diagnosis*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Brain injury; Computed tomography (CT) neuroimaging; Concussion; Decision making; Magnetic resonance imaging (MRI); Mild traumatic brain injury; Post-concussion syndrome; Sports