Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department
| Autor: | Subramanian Subramanian, Sabrina A. Karim, Jennifer R. Marin, Sriram Ramgopal, Andre D. Furtado |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pediatric emergency
Pediatrics medicine.medical_specialty Fast MRI Neurosurgery Neuroimaging 03 medical and health sciences 0302 clinical medicine Child Development 030225 pediatrics Quickbrain MRI medicine Humans Medical diagnosis Child Retrospective Studies Brain Diseases medicine.diagnostic_test business.industry lcsh:RJ1-570 Infant Brain Magnetic resonance imaging Retrospective cohort study lcsh:Pediatrics Emergency department Magnetic Resonance Imaging Neurology Pediatrics Perinatology and Child Health Vomiting Emergency medicine Tomography medicine.symptom Nervous System Diseases business Emergency Service Hospital 030217 neurology & neurosurgery Research Article Rapid MRI |
| Zdroj: | BMC Pediatrics, Vol 20, Iss 1, Pp 1-9 (2020) Pediatric Neurology Briefs BMC Pediatrics |
| ISSN: | 1471-2431 |
| Popis: | Background Rapid magnetic resonance imaging (MRI) protocols may be effective in the emergency department (ED) to evaluate nontraumatic neurologic complaints. We evaluate neuroimaging (rapid MRI [rMRI]), head computerized tomography [HCT], and full MRI) use following widespread implementation of rMRI protocols in a pediatric emergency department (ED). Methods We conducted a retrospective study in a tertiary care pediatric ED of encounters with neuroimaging during two 9-month periods: one prior to (control period) and one after generalized availability of 4 rMRI protocols (rMRI period). The primary outcome was differences in neuroimaging rates between the two periods. Secondary outcomes included ED process measures, unsuccessful imaging, and undetected pathology, with full MRI within 14 days as the reference standard. Results There were 1052 encounters with neuroimaging during the control and 1308 during the rMRI periods. Differences in neuroimaging between periods were 27.7% for rMRI (95% CI, 24.4, 31.0), − 21.5% for HCT (95% CI, − 25.5, − 17.5), and − 6.2% for full MRI (95% CI, − 9.3, − 3.1%.) Time to imaging (182 [IQR 138–255] versus 86 [IQR 52–137] minutes) as well as ED length of stay (396 [IQR 304–484] versus 257 [IQR 196–334] minutes) was longer for rMRI versus HCT (p p p n = 2) and patient motion (n = 20). None of the rMRI studies with full MRI follow-up imaging had undetected pathology; the false negative rate for the HCT exams was as high as 25%. Conclusions After routine ED use of 4 rMRI protocols, there was a more than 20% decrease in HCT use without missed diagnoses. Time to neuroimaging and length of stay were longer for rMRI than HCT, with higher rates of unsuccessful imaging. Despite these limitations, rMRI may be an alternative to HCT for nontraumatic complaints in the ED. |
| Databáze: | OpenAIRE |
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